Remote RN Utilization Review Care Manager (Part-Time)

Intermountain Healthcare Inc.; City of Albany (NY); Remote; USD 57,000 - 86,000; Part time

Job summary

Intermountain Health is seeking an RN Utilization Review Care Management I for flexible, enterprise-wide coverage, including shifts across Peaks/Canyons/Desert regions. The role emphasizes utilization review, clinical decision-making, and collaboration with providers and payers.

Bring RN licensure with compact within service area and a BSN within four years of hire. Expect 8:00 AM–5:00 PM, 2 days of week on average plus weekend coverage and holidays.

Qualifications

• Current Registered Nurse (RN) license in state of practice, and compact licensure within service area.
• BSN within four years of hire or promotion date.
• Experience in care management/navigation or related field including Utilization Management, discharge planning, managed care, or health coaching.

Responsibilities

• Review and investigates medical records to ensure medical necessity and appropriate benefit utilization.
• Apply evidence-based guidelines and policies for prior authorization and post-service reviews.
• Comply with NCQA, CMS, state and plan regulations and communicate clearly with members and providers.
• Engage with providers to ensure safe, efficient care and appropriate settings.
• Collaborate with physicians, staff, members and families to expedite authorizations and transitions of care.
• Respond to inquiries about authorizations and treatment plans.
• Mentor LPNs 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

Bachelor of Science in Nursing

RN license (state of practice)

Compact licensure

Tools

Microsoft Office

Microsoft Teams

Job description

Intermountain Health is seeking an RN Utilization Review Care Management I for flexible, enterprise-wide coverage, including shifts across Peaks/Canyons/Desert regions. The role emphasizes utilization review, clinical decision-making, and collaboration with providers and payers.

Bring RN licensure with compact within service area and a BSN within four years of hire. Expect 8:00 AM–5:00 PM, 2 days of week on average plus weekend coverage and holidays.