Remote RN Utilization Review Specialist

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

Benefits offered by this job

Benefits package

Job summary

Intermountain Healthcare Inc. is seeking an RN Utilization Review Care Management I for a fully remote, part-time role. You will review records, apply clinical guidelines, and collaborate with providers and members to ensure appropriate, cost-effective care across multiple regions.

Remote work and Teams-based collaboration are required. The role emphasizes regulatory compliance, patient-centered care, and support for safe transitions of care, with weekend and holiday coverage, and a compact RN

Qualifications

• Current RN license in state of practice, and compact licensure within service area.
• BSN within four years of hire/promotion.
• Experience in care management/navigation or related field (Utilization Management, discharge planning, managed care, health promotion, health coaching, behavioral health, or Patient Educator).
• Clinical nursing experience in inpatient hospital setting; familiarity with hospital terminology and processes.
• Understanding of disease management including treatment, LOS, barriers to delivery of care, and variation.
• Strong written, verbal communication and conflict resolution skills.
• Ability to work independently in a rapidly changing environment.

Responsibilities

• Review and investigate medical records; apply clinical expertise to ensure appropriate utilization and medical necessity for services.
• Apply evidence-based guidelines (InterQual/MCG) and policies for prior authorization and post-service reviews.
• Follow regulatory guidelines and communicate timely with members, providers, and partners.
• Engage with providers to ensure safe, efficient care and appropriate care setting; assist transitions of care.
• Collaborate with physicians, staff, members, and families to expeditiously obtain authorizations and direct to medically necessary care.
• Engage with members/providers for continuity of care and authorization determinations.
• Resolve queries regarding authorizations, treatment plans, and medical necessity determinations.
• Mentor UM LPN and non-clinical staff on processes and resource use.

Skills

Utilization Management

Clinical Expertise

Investigative Acumen

Medical Diagnosis

Medical Terminology

Time Management

Problem Solving

Quality Care

Communication

Education

BSN

Tools

Microsoft Teams

Outlook

Microsoft Office

Job description

Intermountain Healthcare Inc. is seeking an RN Utilization Review Care Management I for a fully remote, part-time role. You will review records, apply clinical guidelines, and collaborate with providers and members to ensure appropriate, cost-effective care across multiple regions.

Remote work and Teams-based collaboration are required. The role emphasizes regulatory compliance, patient-centered care, and support for safe transitions of care, with weekend and holiday coverage, and a compact RN