Remote Utilization Management Nurse (RN)

Arkansas Blue Cross Blue Shield; North Dakota; Remote; USD 70,000 - 95,000; Full time

Job summary

Arkansas Blue Cross Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews of prior approvals, network exceptions, and inpatient/outpatient procedures. The role requires an active RN license and a Bachelor's degree is preferred, with at least four years of nursing experience.

This position supports work-from-home arrangements across listed states and emphasizes evidence-based patient care, cost containment, and compliance with URAC and state regulations.

Qualifications

• RN with active, unrestricted license in the relevant jurisdiction.
• Bachelor's degree in Nursing preferred.
• Minimum four years of clinical nursing experience in medical-surgical, surgical, ICU or critical care.
• Experience in utilization management or medical review preferred.
• Proficient with Microsoft Office (Word, Excel, Outlook) and able to navigate multiple systems.

Responsibilities

• Conduct clinical review of prior authorizations, network exceptions, benefit inquiries, and admissions.
• Assess medical necessity through evidence-based criteria and guidelines.
• Collaborate with providers and staff to promote appropriate and cost-effective care.
• Document all review findings and ensure compliance with policies and state regulations.
• Maintain current knowledge of medical procedures, products, and contracted policies.

Skills

Interpersonal relationship management

Critical thinking

Time management

Education

Bachelor's degree in Nursing

RN license (active)

Tools

Microsoft Word

Microsoft Outlook

Microsoft SharePoint

Job description

Arkansas Blue Cross Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews of prior approvals, network exceptions, and inpatient/outpatient procedures. The role requires an active RN license and a Bachelor's degree is preferred, with at least four years of nursing experience.

This position supports work-from-home arrangements across listed states and emphasizes evidence-based patient care, cost containment, and compliance with URAC and state regulations.