Remote RN Utilization Review Care Manager

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

Job summary

Intermountain Health is seeking an RN for Utilization Review Care Management I to perform screenings, assessments, and evaluations focused on cost-effective, high-quality care. Remote-friendly role with enterprise-wide shift coverage and weekend rotation; requires RN license with compact licensure and BSN within four years.

The position involves collaborating with patients, families, providers and insurers to ensure medical necessity, adherence to guidelines, and safe transitions of care, while

Qualifications

• RN license to practice in state with compact license in service area.
• BSN from an accredited institution; must obtain BSN within four years if hired/promoted.
• Experience in care management/navigation or related field including Utilization Management.
• Inpatient hospital nursing experience; familiarity with hospital terminology.
• Understanding of disease management and barriers to care.
• Strong written and verbal communication; independent, flexible worker.
• Proficient with Microsoft Office; able to troubleshoot and use multiple monitors.

Responsibilities

• Reviews and investigates medical records to ensure medical necessity and appropriate utilization.
• Applies evidence-based guidelines for prior authorization and post-service reviews.
• Ensures regulatory compliance and timely communication with members and providers.
• Collaborates with providers to ensure safe, efficient care and appropriate settings.
• Engages with members and providers for authorizations and transitions of care.
• Resolves queries regarding authorizations and treatment plans.
• Mentors 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

Tools

Microsoft Office

Microsoft Teams

Outlook

Job description

Intermountain Health is seeking an RN for Utilization Review Care Management I to perform screenings, assessments, and evaluations focused on cost-effective, high-quality care. Remote-friendly role with enterprise-wide shift coverage and weekend rotation; requires RN license with compact licensure and BSN within four years.

The position involves collaborating with patients, families, providers and insurers to ensure medical necessity, adherence to guidelines, and safe transitions of care, while