Remote Utilization Management RN — Mon-Fri, 9a–6p ET

HealthCare Strategies, Inc.; Oregon; Hybrid; USD 65,000 - 90,000; Full time

Job summary

HealthCare Strategies, Inc. is seeking a Utilization Management RN to work from a home office. This full-time role runs Monday to Friday, 9am–6pm ET, offering 40 hours per week and a home-based schedule.

The RN will perform telephonic clinical assessments, collect information from providers and patients, interpret criteria for inpatient and outpatient services, and document outcomes in the system. A valid RN license is required and hospital experience is preferred.

Qualifications

• Strong verbal communication and interpersonal skills.
• Ability to follow detailed written or verbal instructions independently.
• Proficient with Microsoft Office Suite (Outlook, Word).

Responsibilities

• Perform telephonic Clinical Assessments.
• Obtain information from provider/patient/family about planned procedure, admission, or discharge.
• Interpret nationally recognized criteria to support recommendations for inpatient and outpatient services.
• Identify and refer individuals for Case Management.
• Document calls completely and promptly into the computer system.
• Follow policies for handling confidential materials and patient information.
• Answer calls to determine if prior authorization is required.
• Retrieve and acknowledge voicemail messages requesting medical services.
• Complete medical necessity reviews and communicate outcomes to providers within required timeframes.
• Provide educational materials and direct callers to community services.
• Provide coverage for professional colleagues.

Skills

Strong verbal communication

Problem-solving

Attention to detail

Education

Active, unrestricted RN license

Tools

Microsoft Office Suite (Outlook, Word)

Job description

HealthCare Strategies, Inc. is seeking a Utilization Management RN to work from a home office. This full-time role runs Monday to Friday, 9am–6pm ET, offering 40 hours per week and a home-based schedule.

The RN will perform telephonic clinical assessments, collect information from providers and patients, interpret criteria for inpatient and outpatient services, and document outcomes in the system. A valid RN license is required and hospital experience is preferred.