Remote Utilization Management RN: Concurrent Review

Santa Barbara Cottage Hospital; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

Impresiv Health is seeking an experienced Concurrent Review Registered Nurse (RN) to join its Utilization Management team remotely. You will perform concurrent reviews, prior authorizations, and discharge planning while collaborating with physicians and hospitals to ensure cost-effective, evidence-based care.

The role requires strong clinical judgment, 4+ years nursing experience, and 2+ years in managed care, with proficiency in InterQual, MCG, CMS guidelines and medical management software.

Qualifications

• Active RN license with multi-state licensure ability.
• Minimum 4 years of clinical nursing experience.
• Minimum 2 years in managed care or HMO.
• Experience performing medical necessity reviews using guidelines.
• Knowledge of concurrent review, utilization management, discharge planning.

Responsibilities

• Perform concurrent, prior authorization, and retrospective utilization reviews.
• Evaluate medical necessity using InterQual, MCG, CMS guidelines.
• Coordinate discharge planning and transitions of care with providers.
• Collaborate with physicians, hospital staff, and care teams.
• Review additional documentation when needed and escalate complex cases.
• Educate providers on policies and review criteria.
• Document reviews and decisions in management systems.
• Identify care gaps and support quality improvement efforts.
• Serve as a clinical resource for internal teams.

Skills

Clinical judgment

Communication skills

Organizational skills

Critical thinking

Detail-oriented

Education

Graduate of an accredited School of Nursing

BSN (preferred)

Tools

Medical management software

Microsoft Office

Job description

Impresiv Health is seeking an experienced Concurrent Review Registered Nurse (RN) to join its Utilization Management team remotely. You will perform concurrent reviews, prior authorizations, and discharge planning while collaborating with physicians and hospitals to ensure cost-effective, evidence-based care.

The role requires strong clinical judgment, 4+ years nursing experience, and 2+ years in managed care, with proficiency in InterQual, MCG, CMS guidelines and medical management software.