Remote Utilization Management RN – Outcomes Focus

Guidehealth; Gary (IN); On-site; USD 70,000 - 75,000; Full time

Benefits offered by this job

Work from Home

Health, Dental, Vision

Job summary

Guidehealth, a fully remote healthcare company, is seeking a Utilization Management Registered Nurse to perform reviews, apply medical necessity criteria, and document findings in support of determinations. You will collaborate with the Medical Director and peers to ensure timely, compliant reviews while maintaining patient confidentiality and data security.

The role emphasizes AI integration into daily workflows and high-quality care.

Qualifications

• Active Illinois RN license
• 3 years experience in healthcare settings
• Knowledge of utilization review, managed care, and population health

Responsibilities

• Perform utilization reviews (precertification and concurrent) using medical necessity criteria
• Document clinical findings and determinations in compliance with standards
• Communicate review outcomes to providers and members within required timeframes
• Collaborate with Medical Director and peers on complex cases and QA activities

Skills

Nursing license

Utilization review

Microsoft 365

Tools

EMR systems

Job description

Guidehealth, a fully remote healthcare company, is seeking a Utilization Management Registered Nurse to perform reviews, apply medical necessity criteria, and document findings in support of determinations. You will collaborate with the Medical Director and peers to ensure timely, compliant reviews while maintaining patient confidentiality and data security.

The role emphasizes AI integration into daily workflows and high-quality care.