Remote Utilization Management Nurse

Curana Health; Idaho; Remote; USD 75,000 - 95,000; Full time

Job summary

Curana Health seeks an experienced Utilization Management Nurse to review and monitor members’ use of healthcare services, ensuring high-quality, cost-effective care. The role emphasizes concurrent review, discharge planning, and high-dollar claims analysis, with remote telephonic duties and occasional weekend coverage.

The position collaborates with the Plan Medical Director and Quality Improvement to ensure appropriate authorizations and care transitions across hospital and SNF settings.

Qualifications

• Minimum 2 years clinical experience as RN, LPN/LVN.
• Experience in health plan utilization management and discharge planning.
• Medicare Advantage experience preferred.
• Experience with InterQual or MCG criteria preferred.

Responsibilities

• Performs concurrent and retrospective reviews on facility and home health services.
• Monitors level and quality of care; supports discharge planning.
• Communicates with providers regarding discharge plans and covered services.
• Prepares CMS-compliant notification letters for NON-certification/negotiated days.
• Maintains accurate records of communications and utilization data.
• Coordinates with Quality Improvement and Medical Directors for decisions.
• Works as part of an interdisciplinary Medical Management team.

Skills

RN or LPN/LVN experience

Managed care experience

Utilization management knowledge

InterQual/MCG criteria familiarity

Interpersonal skills

Tools

InterQual

MCG criteria

EHR systems

Job description

Curana Health seeks an experienced Utilization Management Nurse to review and monitor members’ use of healthcare services, ensuring high-quality, cost-effective care. The role emphasizes concurrent review, discharge planning, and high-dollar claims analysis, with remote telephonic duties and occasional weekend coverage.

The position collaborates with the Plan Medical Director and Quality Improvement to ensure appropriate authorizations and care transitions across hospital and SNF settings.