Remote Utilization Management Nurse

Vālenz Health; Northern (KY); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Generous paid time off

Remote work with equipment provided

Health insurance options

Job summary

Valenz Health is seeking a Utilization Management Nurse to oversee and manage the UM process, ensuring the delivery of high-quality, cost-effective care for plan participants. You will review prospective, concurrent, and retrospective UM activities and collaborate with internal teams and healthcare professionals to ensure compliance with CMS, URAC, and other regulators.

This fully remote role requires a US-based location, strong nursing background, and ability to work in a fast-paced environment

Qualifications

• 3+ years of clinical nursing experience.
• Active, Unrestricted RN License in your state of residence.
• Ability to work in a fast-paced, detail-oriented, deadline-driven environment.
• Ability to maintain strict confidentiality and handle sensitive information with discretion.
• Experience working independently with strong problem solving and organization skills.
• Strong aptitude for relationship building with effective communication.

Responsibilities

• Conduct timely UM reviews (prospective, concurrent, retrospective) and apply UM criteria.
• Collaborate with teams to ensure appropriate timelines and CMS/URAC guidelines.
• Identify overutilization or underutilization and refer cases as needed.
• Communicate UM decisions to providers and plan participants.
• Maintain accurate records and ensure confidentiality of information.
• Participate in ongoing UM education and training.

Skills

Clinical nursing experience

RN License

Confidentiality and discretion

Independent work and problem solving

Communication skills

Education

RN License (state of residence)

Job description

Valenz Health is seeking a Utilization Management Nurse to oversee and manage the UM process, ensuring the delivery of high-quality, cost-effective care for plan participants. You will review prospective, concurrent, and retrospective UM activities and collaborate with internal teams and healthcare professionals to ensure compliance with CMS, URAC, and other regulators.

This fully remote role requires a US-based location, strong nursing background, and ability to work in a fast-paced environment