Remote Utilization Management RN - Elevate Care & Cost Efficiency

Arkansas Blue Cross Blue Shield; Arkansas; Remote; USD 85,000 - 120,000; Full time

Job summary

Arkansas Blue Cross Blue Shield is seeking an experienced Utilization Management Nurse who will perform clinical review of prior approvals, network exceptions, and benefit inquiries, ensuring medical necessity through evidence-based guidelines. The role requires a current RN license in good standing and typically four years of clinical practice in medical-surgical, surgical, ICU, or critical care.

You will work from home across Arkansas and several other states, using Microsoft Office tools to

Qualifications

• Active RN license in the relevant state(s) where duties are performed.
• Minimum four years of clinical practice nursing experience in medical-surgical, surgical, ICU, or critical care.
• Bachelor's degree in Nursing preferred.
• Experience with utilization management or medical review is a plus.
• Proficient in Microsoft Office and navigating multiple systems.

Responsibilities

• Perform clinical review of prior approvals, network exceptions, and benefit inquiries.
• Assess medical necessity and ensure appropriate level of care using evidence-based guidelines.
• Collaborate with providers and internal staff to promote quality and cost containment.
• Document findings and maintain compliance with URAC standards and state regulations.
• Work from home within specified states; prioritize nursing judgments and patient safety.

Skills

Interpersonal Relationship Management

Time Management

Education

Registered Nurse license in good standing

Bachelor's degree in Nursing preferred

Tools

Microsoft Outlook

Microsoft SharePoint

Microsoft Word

Job description

Arkansas Blue Cross Blue Shield is seeking an experienced Utilization Management Nurse who will perform clinical review of prior approvals, network exceptions, and benefit inquiries, ensuring medical necessity through evidence-based guidelines. The role requires a current RN license in good standing and typically four years of clinical practice in medical-surgical, surgical, ICU, or critical care.

You will work from home across Arkansas and several other states, using Microsoft Office tools to