Remote RN Utilization Review Care Manager

Intermountain Healthcare Inc.; Santa Fe (NM); Remote; USD 57,000 - 86,000; Part time

Job summary

Intermountain Health is seeking an RN Utilization Review Care Management I for remote work. The role focuses on screenings, assessments, and evaluations to ensure cost-effective, high-quality care while coordinating with patients, families, providers, and payers.

This part-time, fully remote position covers enterprise-wide shifts, with typical hours 8:00 AM–5:00 PM, and requires RN licensure with compact state licensure, BSN within four years, and experience in utilization management.

Qualifications

• Current RN license in state; compact licensure within service area.
• BSN from an accredited institution; degree verification required; BSN to be obtained within four years.
• Experience in care management/utilization management and related fields.
• Inpatient hospital experience; familiarity with hospital terminology and processes.

Responsibilities

• Reviews and investigates medical records to ensure appropriate benefit utilization and medical necessity.
• Applies evidence-based guidelines and medical policies for prior authorization and post-service reviews.
• Adheres to regulatory guidelines and communicates with members, providers, and partners.
• Engages with providers to ensure safe, efficient care and appropriate setting for services.
• Collaborates with physicians and staff to expeditiously authorize and direct to medically necessary care.
• Resolves queries regarding authorizations, plans, and medical necessity determinations.
• Mentors UM LPN and non-clinical staff on processes and resource applications.

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 Utilization Review Care Management I for remote work. The role focuses on screenings, assessments, and evaluations to ensure cost-effective, high-quality care while coordinating with patients, families, providers, and payers.

This part-time, fully remote position covers enterprise-wide shifts, with typical hours 8:00 AM–5:00 PM, and requires RN licensure with compact state licensure, BSN within four years, and experience in utilization management.