Remote RN Utilization Review Care Manager (Part-Time)

Intermountain Healthcare Inc.; Salem (OR); 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 in a fully remote, part-time role. The position emphasizes utilization review screenings, assessments, and coordinating with patients, providers, and payers to ensure high-quality, cost-effective care.

Responsibilities include applying evidence-based guidelines, coordinating with teams, and ensuring compliant reviews. Remote work options are offered where approved per posting.

Qualifications

• Current Registered Nurse (RN) license in state of practice, and compact licensure within service area.
• Bachelor of Science in Nursing (BSN) from an accredited institution (degree verification required). RNs hired or promoted into this role must obtain their BSN within four (4) years of hire or promotion date.
• Demonstrated experience in care management/navigation or closely related field including: Utilization Management, discharge planning, managed care, health promotion, health coaching, behavioral health, or Patient Educator job role.
• Demonstrated clinical nursing experience in an inpatient hospital setting, and familiarity with hospital patient-related terminology and processes.
• Demonstrated understand of disease management including treatment, length of stay, identifying barriers to delivery of care and any variation.
• Strong written, verbal communication and conflict resolution skills
• Basic computer hardware set-up, ability to customize computer settings and use multiple monitors and capable of independent troubleshooting internet and applications. Knowledge of Microsoft Office software.
• Ability to work independently, be self-motivated, have a positive attitude, and be flexible in a rapidly changing environment.
• Strong written, verbal communication and conflict resolution skills

Responsibilities

• Reviews and investigates medical records and applies clinical expertise to assure appropriate benefit utilization and medical necessity as relates to requested services, authorization history, and treatment plan.
• Uses in-depth knowledge of medical procedures, treatments, and diagnosis to apply evidence-based guidelines (e.g. InterQual/MCG) and medical policies for prior authorization and post service reviews.
• Follows the applicable regulatory guidelines (NCQA, CMS, State, plan) and ensures timely review with clear and accurate communication to members and requesting providers. Adheres to regulatory guidelines and timely communication with members, providers, and internal/external partners.
• Based on medical necessity and clinical best practice, proactively engages with providers to ensure safe and efficient medical care, appropriate care setting, and safe transitions of care referring to alternate programs as applicable.
• Collaborates with physicians, internal staff, members, and families to assist in expediting the requested authorizations, and directs toward medically necessary care and the correct level/setting for services requested.
• Engage proactively with members and providers for safe, efficient care and transitions as applicable to continuity of care, redirection, and authorization determination.
• Resolves queries regarding authorizations, treatment plans, and medical necessity determinations.
• Mentors and guides the UM LPN & non-clinical on process/clinical questions and application of resources.

Skills

Utilization Management

Clinical Expertise

Investigative Acumen

Medical Diagnosis & Treatment

Medical Terminology

Time Management

Problem Solving

Quality Care

Communication

Education

RN license

BSN

Job description

Intermountain Health is seeking an RN Utilization Review Care Management I for St. Marys Regional Hospital in a fully remote, part-time role. The position emphasizes utilization review screenings, assessments, and coordinating with patients, providers, and payers to ensure high-quality, cost-effective care.

Responsibilities include applying evidence-based guidelines, coordinating with teams, and ensuring compliant reviews. Remote work options are offered where approved per posting.