Remote RN: Utilization Review & Care Manager

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

Benefits offered by this job

Benefits package

PEAK program

Job summary

Intermountain Health is seeking an RN Utilization Review Care Management I for a fully remote, part-time role. The position covers enterprise-wide shifts with on-call and weekend rotations, requiring RN licensure with a compact license within the service area.

Responsibilities include reviews, prior authorizations, and collaboration with providers to ensure cost-effective, high-quality care. The role emphasizes utilization management, patient-centered care, and regulatory compliance, with a

Qualifications

• RN licensure in state of practice, and compact licensure within service area.
• BSN from an accredited institution; must obtain BSN within four years of hire/promotion.

Responsibilities

• Review and investigate medical records to ensure medical necessity and appropriate utilization.
• Apply evidence-based guidelines (InterQual/MCG) for prior authorization and 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 and families to expedite authorizations and referrals.
• Proactively engage with members/providers for continuity of care and authorization decisions.
• Resolve queries on authorizations and treatment plans.
• 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

Job description

Intermountain Health is seeking an RN Utilization Review Care Management I for a fully remote, part-time role. The position covers enterprise-wide shifts with on-call and weekend rotations, requiring RN licensure with a compact license within the service area.

Responsibilities include reviews, prior authorizations, and collaboration with providers to ensure cost-effective, high-quality care. The role emphasizes utilization management, patient-centered care, and regulatory compliance, with a