Remote RN Utilization Review Care Manager (Part-Time)

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

Job summary

Intermountain Health is seeking an RN Utilization Review Care Management I for St. Marys Regional Hospital. This fully remote role involves coordinating utilization reviews, applying evidence-based guidelines, and ensuring compliant, cost-effective care.

Flexible options and strong collaboration with providers, patients, and payers are essential. Position details include average 2 days per week plus 2 weekends every 8 weeks, with holiday coverage and a compact license.

Qualifications

• Active RN license in state of practice with compact licensure within service area.
• BSN required within four years of hire or promotion.
• Experience in care management/navigation or related field.
• Inpatient hospital nursing experience and familiarity with hospital terminology.
• Understanding of disease management, barriers to care, and variation.
• Strong written, verbal communication and conflict resolution skills.
• Proficient with computers and MS Office; able to troubleshoot independently.
• Ability to work independently in a dynamic environment.

Responsibilities

• Reviews and investigates medical records to ensure appropriate benefit utilization and medical necessity.
• Applies guidelines (e.g., InterQual/MCG) and policies for prior authorization and post-service reviews.
• Adheres to regulatory requirements and communicates timely with members and providers.
• Engages with providers to ensure safe, efficient care and appropriate settings.
• Collaborates with physicians, staff, members, and families to expedite authorizations.
• Engages with members/providers for continuity of care and authorization determinations.
• Resolves questions 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

Medical Terminology

Time Management

Problem Solving

Quality Care

Communication

Education

RN license in state

Compact licensure within service area

BSN within 4 years of hire

Tools

Microsoft Office

Microsoft Teams

Job description

Intermountain Health is seeking an RN Utilization Review Care Management I for St. Marys Regional Hospital. This fully remote role involves coordinating utilization reviews, applying evidence-based guidelines, and ensuring compliant, cost-effective care.

Flexible options and strong collaboration with providers, patients, and payers are essential. Position details include average 2 days per week plus 2 weekends every 8 weeks, with holiday coverage and a compact license.