Remote UM RN - Physical Health Specialist

Alliance Health; Morrisville (NC); Hybrid; USD 70,000 - 89,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Long-term disability

Retirement plan

Flexible schedules (hybrid/remote)

Paid time off

Dress flexibility

Job summary

Alliance Health seeks an RN in Utilization Management to independently assess medical necessity for inpatient and outpatient services, and to monitor treatment through reviews. The role supports cross-agency collaboration and may operate remotely with office visits for meetings.

The candidate should have NC RN licensure (or compact), and 5+ years of nursing experience, plus UM experience preferred. Hybrid/remote options and comprehensive benefits are included.

Qualifications

• State-accredited nursing degree or ADN with at least five years of nursing experience
• Bachelor’s degree in Nursing with three years of nursing experience
• Current, active, and unrestricted North Carolina nursing license or compact license
• Experience in Utilization Management is preferred

Responsibilities

• Assess the medical necessity of services for inpatient and outpatient care, surgical and diagnostic procedures
• Conduct pre-certification, concurrent, and retrospective reviews to ensure policy and contract compliance
• Notify members of adverse determinations while preserving Due Process rights
• Ensure services address appropriate needs and consider alternatives for consumers
• Collaborate with departments to integrate UM processes and maintain timelines

Skills

Nursing

Collaboration

Documentation

Microsoft Office

Written Communication

Education

Technical/other training or better in Nursing

Associates or better in Nursing

Job description

Alliance Health seeks an RN in Utilization Management to independently assess medical necessity for inpatient and outpatient services, and to monitor treatment through reviews. The role supports cross-agency collaboration and may operate remotely with office visits for meetings.

The candidate should have NC RN licensure (or compact), and 5+ years of nursing experience, plus UM experience preferred. Hybrid/remote options and comprehensive benefits are included.