Remote Utilization Management RN — Clinical Review

Imagine360; United States; On-site; USD 75,000 - 105,000; Full time

Benefits offered by this job

Health plans

Premium disability & life insurance

PTO 20 days

Holidays 10

Tuition reimbursement

401k

Disability & life insurance

Professional development

Diversity & inclusion

Job summary

Imagine360 is seeking a Utilization Management, RN for a 100% remote role. The candidate will perform medical necessity reviews, document findings in CaseTrakker, and guide non-clinical staff on clinical data interpretation.

You will collaborate with physician advisors and participate in QA activities. The position requires an active RN license in an eNLC state and 1+ year in Utilization Management, with preference for CCM certification and a Bachelor's degree.

Qualifications

• Nursing degree from an accredited college or university with an active, current RN license (eNLC).
• 1+ year in Utilization Management or Case Management preferred.
• Experience in utilization review services preferred; CPT/ICD knowledge helpful.

Responsibilities

• Perform utilization reviews to determine medical necessity per guidelines.
• Document reviews accurately in CaseTrakker and other systems.
• Provide guidance to non-clinical staff on clinical data interpretation.
• Communicate with physicians and peer reviewers per policy.
• Educate members using approved resources and participate in QA reviews.
• Attend meetings, trainings, and other job-specific events.
• Maintain patient privacy and confidentiality in all processes.

Skills

HIPAA compliance

Policy interpretation

Written communication

Microsoft Office

Data interpretation

Education

Nursing degree

RN license (eNLC)

Bachelor's degree preferred

Tools

CaseTrakker

Office software

Database software

Internet software

Job description

Imagine360 is seeking a Utilization Management, RN for a 100% remote role. The candidate will perform medical necessity reviews, document findings in CaseTrakker, and guide non-clinical staff on clinical data interpretation.

You will collaborate with physician advisors and participate in QA activities. The position requires an active RN license in an eNLC state and 1+ year in Utilization Management, with preference for CCM certification and a Bachelor's degree.