Remote RN: Utilization Review Care Manager

Intermountain Healthcare Inc.; Frankfort (KY); Remote; USD 57,000 - 86,000; Part time

Job summary

Intermountain Health is seeking an RN Utilization Review Care Management I for enterprise-wide utilization review work in a fully remote role. The position involves reviewing medical records, applying clinical guidelines, and coordinating authorizations to promote cost-effective, high-quality care.

Required are an RN license with compact licensure and a BSN. The role includes shift coverage with 8:00 AM – 5:00 PM hours and periodic weekend/holiday coverage, with video interviews via Teams as

Qualifications

• Current RN license in state of practice with compact licensure.
• BSN from an accredited program; BSN must be obtained within four years if hired/promoted.
• Experience in care management/navigation or Utilization Management preferred.

Responsibilities

• Reviews medical records and applies clinical expertise to ensure appropriate benefit utilization and medical necessity.
• Applies evidence-based guidelines and policies for prior authorization and post-service reviews.
• Adheres to regulatory guidelines and communicates findings clearly to members and providers.
• Collaborates with physicians, staff, and families to expedite authorizations and ensure safe care transitions.
• Mentors UM LPN and non-clinical staff on processes and resource utilization.

Skills

Utilization Management

Clinical Expertise

Investigative Acumen

Medical Diagnosis & Treatment

Medical Terminology

Time Management

Problem Solving

Quality Care

Communication

Education

BSN - Accredited program

RN license with compact licensure

Tools

Microsoft Office

Job description

Intermountain Health is seeking an RN Utilization Review Care Management I for enterprise-wide utilization review work in a fully remote role. The position involves reviewing medical records, applying clinical guidelines, and coordinating authorizations to promote cost-effective, high-quality care.

Required are an RN license with compact licensure and a BSN. The role includes shift coverage with 8:00 AM – 5:00 PM hours and periodic weekend/holiday coverage, with video interviews via Teams as