Remote Utilization Management RN: Quality & Cost Care

Arkansas Blue Cross Blue Shield; Idaho; Remote; USD 85,000 - 110,000; Full time

Job summary

Arkansas Blue Cross Blue Shield seeks an experienced Utilization Management Nurse to review prior approvals, network exceptions, and medical necessity for inpatient and outpatient services. The role emphasizes evidence-based decision-making, collaboration with providers, and cost-effective care across contracted lines of business.

The ideal candidate is an RN with an active license, a BSN preferred, and at least four years of clinical nursing experience in medical/surgical, surgical, ICU, or

Qualifications

• RN license active in relevant jurisdiction.
• BSN preferred; RN with active license required.
• 4+ years of clinical practice in medical/surgical, surgical, ICU or critical care.
• Experience in utilization management or medical review preferred.
• Proficient with Microsoft Office; able to navigate multiple systems.

Responsibilities

• Perform clinical review of prior approvals and medical necessity.
• Assess network exceptions and benefit inquiries for services.
• Collaborate with providers and internal staff to ensure appropriate care.
• Promote cost containment and quality through evidence-based review.

Skills

Clinical review

Nursing practice

MS Office

Critical thinking

Time management

Education

RN license

BSN preferred

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Microsoft SharePoint

Job description

Arkansas Blue Cross Blue Shield seeks an experienced Utilization Management Nurse to review prior approvals, network exceptions, and medical necessity for inpatient and outpatient services. The role emphasizes evidence-based decision-making, collaboration with providers, and cost-effective care across contracted lines of business.

The ideal candidate is an RN with an active license, a BSN preferred, and at least four years of clinical nursing experience in medical/surgical, surgical, ICU, or