Remote Utilization Management RN

Guidehealth; Gary (IN); Remote; USD 70,000 - 75,000; Full time

Benefits offered by this job

Work from home

401(k) plan

Life and disability insurance

Paid time off

Job summary

Guidehealth is seeking an Utilization Management Registered Nurse to perform medical-necessity reviews and document findings for determinations. The role involves collaborating with medical leadership, reviewing cases for appropriate treatments, and ensuring timely decisions in a remote work environment.

Ideal candidates hold an active IL RN license, have 3+ years in healthcare settings, and are proficient with Microsoft 365.

Qualifications

• RN with an active and unrestricted Illinois State License.
• Three years of experience in diverse healthcare settings.
• Knowledge of utilization review, managed care, and community health.
• 20 hours of CE per 2-year license renewal cycle.
• Strong organizational, writing, and speaking skills.
• Proficient computer skills including Microsoft 365.

Responsibilities

• Perform timely utilization reviews (precertification and concurrent) using approved criteria.
• Document clinical findings and determinations per regulatory and accreditation standards.
• Communicate review decisions to providers, members, and required parties within timelines.
• Collaborate with Medical Director and peer reviewers on complex cases.
• Assist in QA activities and contribute to performance improvement.

Skills

Nurse license

Healthcare experience

Utilization review

Microsoft 365

Communication

Tools

Microsoft 365

Job description

Guidehealth is seeking an Utilization Management Registered Nurse to perform medical-necessity reviews and document findings for determinations. The role involves collaborating with medical leadership, reviewing cases for appropriate treatments, and ensuring timely decisions in a remote work environment.

Ideal candidates hold an active IL RN license, have 3+ years in healthcare settings, and are proficient with Microsoft 365.