Remote Utilization Management Nurse (PACE)

Santa Barbara Cottage Hospital; United States; Remote; USD 47,733 - 67,984; Full time

Benefits offered by this job

1 year contract

Collaborative environment

Job summary

IntusCare is seeking a Contract Utilization Management Nurse to ensure high-quality, cost-effective, and compliant care for PACE participants. The role collaborates with interdisciplinary teams to review utilization, guide care decisions, and support transitions across care settings.

The position is fully remote within the United States and offers a 1-year contract with potential extension. Compensation is $42.00 per hour, with sponsorship not available.

Qualifications

• 3 to 5 years of utilization management experience.
• Current RN license.
• Proven experience working in risk based integrated models of care.
• Ability to use data to drive decisions and collaboration with internal and external stakeholders.
• Strong strategic thinking, problem solving, and decision making skills.
• Excellent communication and leadership abilities, capable of motivating and guiding teams toward timely and efficient care management strategies

Responsibilities

• Concurrent review of hospital admissions (observation and inpatient) with the Interdisciplinary Team for timely transitions and compliance with service authorization.
• Concurrent review of subacute and SNF admissions with the Interdisciplinary Team to support discharge plans.
• Coordinate and review all other services from contracted providers to ensure consistency with care plans and PCP decisions.
• Advocate quality care and enhanced quality of life.
• Advocate shorter hospital stays when appropriate.
• Maintain accurate records of all patient interactions.
• Lead provider appeals during claim denials and coordinate with Medical Director to issue determinations and written responses.

Skills

Utilization management

RN license

Data-driven decisions

Stakeholder collaboration

Leadership

Risk-based care

Job description

IntusCare is seeking a Contract Utilization Management Nurse to ensure high-quality, cost-effective, and compliant care for PACE participants. The role collaborates with interdisciplinary teams to review utilization, guide care decisions, and support transitions across care settings.

The position is fully remote within the United States and offers a 1-year contract with potential extension. Compensation is $42.00 per hour, with sponsorship not available.