Remote RN Utilization Review Care Manager

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

Job summary

Intermountain Health is seeking an RN Utilization Review Care Management I to perform utilization review screenings, assessments, and evaluations with a focus on cost-effective, high-quality care. The role collaborates with patients, families, providers, and insurers to ensure compliant and efficient utilization review services.

We offer flexible work options where approved, with holiday and weekend coverage as part of an enterprise-wide shift schedule.

Qualifications

• Current RN license in state of practice; compact licensure within service area.
• BSN required within four years of hire/promotion.
• Experience in care management/navigation or Utilization Management, discharge planning, managed care, health promotion.
• Clinical nursing experience in inpatient hospital setting; familiarity with hospital terminology.
• Understanding of disease management, barriers to care, and variations in treatment.
• Strong written and verbal communication and conflict resolution skills.
• Proficiency with Microsoft Office and ability to troubleshoot computer and monitor setup.

Responsibilities

• Review and investigate medical records to ensure appropriate benefit utilization and medical necessity.
• Apply evidence-based guidelines (InterQual/MCG) and policies for prior authorization and post-service reviews.
• Follow regulatory guidelines and communicate timely with members and providers.
• Engage with providers to ensure safe, efficient care and appropriate care setting.
• Collaborate with physicians, staff, and families to expedite authorizations and direct to appropriate care.
• Engage with members/providers for continuity of care and authorization decisions.
• Resolve queries regarding authorizations and medical necessity.
• Mentor UM LPN and non-clinical staff on processes and resources.

Skills

Utilization Management

Clinical Expertise

Investigative Acumen

Medical Diagnosis & Treatment

Medical Terminology

Time Management

Problem Solving

Quality Care

Communication

Education

BSN (Bachelor of Science in Nursing)

Job description

Intermountain Health is seeking an RN Utilization Review Care Management I to perform utilization review screenings, assessments, and evaluations with a focus on cost-effective, high-quality care. The role collaborates with patients, families, providers, and insurers to ensure compliant and efficient utilization review services.

We offer flexible work options where approved, with holiday and weekend coverage as part of an enterprise-wide shift schedule.