Remote Utilization Management RN - Care Outcomes Advocate

QuickCruit, Inc.; Northern (KY); Hybrid; USD 70,000 - 100,000; Full time

Job summary

QuickCruit, Inc. is seeking a Utilization Management RN to collaborate with the Medical Director and Health Plan Manager. You will drive reductions in care variance, ensure timely discharges, and refer members to plan resources to meet care conditions.

In this remote U.S. role, you will contribute to care management review processes and educate stakeholders, supporting an integrated medical management team focused on optimal patient outcomes.

Qualifications

• Current Registered Nurse license in the state where services are provided or multi-state license via eNLC.
• Three (3) years of healthcare clinical experience.
• Bachelor's Degree in Nursing or ASN; BSN completion within three years of hire.
• Medicare and/or Medicaid medical management experience.
• Utilization Management experience.

Responsibilities

• Assist with building and implementing care management review processes (Prior Authorization, Predetermination, Concurrent Reviews, Retrospective Reviews).
• Develop and apply care management reviews per criteria and clinical guidelines.
• Ensure interventions maximize member health care outcomes.
• Collaborate with Medical Directors to improve member and Provider Network services in Peer-to-Peer Review.
• Educate internal and external stakeholders to improve processes and build network relationships.
• Work with medical management team to identify members who may benefit from coaching or case management.

Skills

RN license

Healthcare experience

BSN/ASN

eNLC license

Utilization Management

Education

Bachelor's Degree in Nursing

ASN (Associate of Science in Nursing)

BSN in progress

Job description

QuickCruit, Inc. is seeking a Utilization Management RN to collaborate with the Medical Director and Health Plan Manager. You will drive reductions in care variance, ensure timely discharges, and refer members to plan resources to meet care conditions.

In this remote U.S. role, you will contribute to care management review processes and educate stakeholders, supporting an integrated medical management team focused on optimal patient outcomes.