Remote RN Utilization Review Care Manager

Intermountain Healthcare Inc.; Lansing (MI); 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. The role focuses on responsible resource stewardship, cost-effective, high-quality care, and collaboration with patients, families, providers, and insurers.

The position supports flexible work options where approved, with shift coverage enterprise-wide and weekend/holiday requirements. Requires RN licensure with compact, and BSN within four years.

Qualifications

• Current RN license in state of practice with compact licensure.
• BSN from an accredited institution—must obtain BSN within four years of hire/promotion.
• Experience in care management/navigation or related field including Utilization Management, discharge planning, managed care, or health coaching.

Responsibilities

• Review and investigate medical records to assure appropriate benefit utilization and medical necessity.
• Apply evidence-based guidelines and policies for prior authorization and post-service reviews.
• Ensure regulatory compliance and timely communication with members, providers, and partners.
• Engage with providers to coordinate safe, efficient care and appropriate care setting.
• Assist in expediting authorizations and directing to medically necessary care and setting.

Skills

Utilization Management

Care Management

Clinical Nursing

Documentation

Communication

Time Management

Problem Solving

Quality Care

Education

BSN

RN Licensure (compact)

Tools

Microsoft Office

Job description

Intermountain Health is seeking an RN Utilization Review Care Management I to perform utilization review, screenings, assessments, and evaluations. The role focuses on responsible resource stewardship, cost-effective, high-quality care, and collaboration with patients, families, providers, and insurers.

The position supports flexible work options where approved, with shift coverage enterprise-wide and weekend/holiday requirements. Requires RN licensure with compact, and BSN within four years.