Remote Utilization Management Nurse - Part-Time

Santa Barbara Cottage Hospital; United States; Remote; USD 55,000 - 83,000; Part time

Job summary

nirvanaHealth is seeking a part-time Utilization Management (UM) Nurse to join our remote team. The UM Nurse will perform prospective, concurrent, and retrospective medical necessity reviews, determine level of care, and participate in initial clinical review to ensure high-quality, cost-efficient care within regulatory standards.

This remote role accounts for 12 hours per week, with 4 hours on Friday evening and 4 hours on Saturday and Sunday.

Qualifications

• Associate degree in nursing is required.
• Bachelor’s degree in nursing is preferred.

Responsibilities

• Performs prospective, concurrent, and retrospective medical necessity reviews.
• Determines level of care and monitors length of stay.
• Conducts initial clinical review.
• Ensures timeliness and accuracy of reviews.
• Coordinates discharge planning with care team.
• Communicates with members/providers/facilities citing criteria.

Skills

RN

Utilization management

Case management

Medical necessity

Clinical judgement

MS Word

Excel

PowerPoint

Education

Associate's degree in nursing

Bachelor’s degree in nursing preferred

Tools

MS Word

Excel

Access

PowerPoint

Job description

nirvanaHealth is seeking a part-time Utilization Management (UM) Nurse to join our remote team. The UM Nurse will perform prospective, concurrent, and retrospective medical necessity reviews, determine level of care, and participate in initial clinical review to ensure high-quality, cost-efficient care within regulatory standards.

This remote role accounts for 12 hours per week, with 4 hours on Friday evening and 4 hours on Saturday and Sunday.