Remote RN Utilization Review Specialist

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

Job summary

Intermountain Health’s St. Marys Regional Hospital seeks an RN Utilization Review Care Management I to perform utilization review screenings, assessments, and evaluations, focusing on cost-effective, high-quality care.

The role involves collaboration with patients, families, providers, and insurers to ensure compliant, efficient, and patient-centered services. Remote work is offered where approved, with shifts enterprise-wide and occasional weekends/holidays.

Qualifications

• Current RN license (in state of practice) and compact licensure within service area.
• BSN within four years of hire or promotion.
• Experience in care management/navigation or related field such as Utilization Management, discharge planning, managed care.
• Inpatient hospital nursing experience; familiarity with hospital terminology and processes.
• Strong written and verbal communication and conflict resolution skills.

Responsibilities

• Reviews medical records and applies clinical expertise to ensure appropriate benefit utilization and medical necessity.
• Applies evidence-based guidelines (InterQual/MCG) for prior authorization and post-service reviews.
• Adheres to regulatory guidelines and ensures timely communication with members and providers.
• Engages with providers to ensure safe and efficient care and appropriate care settings.
• Collaborates with physicians, staff, members, and families to expedite authorizations and direct to medically necessary care.
• Proactively engage with members for safe, efficient care and continuity of care.
• Resolves queries regarding authorizations, treatment plans, and medical necessity.
• Mentors UM LPN and non-clinical staff on processes and resource application.

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

Job description

Intermountain Health’s St. Marys Regional Hospital seeks an RN Utilization Review Care Management I to perform utilization review screenings, assessments, and evaluations, focusing on cost-effective, high-quality care.

The role involves collaboration with patients, families, providers, and insurers to ensure compliant, efficient, and patient-centered services. Remote work is offered where approved, with shifts enterprise-wide and occasional weekends/holidays.