Remote Utilization Management RN: Value-Based Care

Guidehealth; Davenport (IA); Hybrid; USD 70,000 - 75,000; Full time

Benefits offered by this job

Work from Home

Medical insurance

401(k) employer match

Life and Disability insurance

EAP

Paid time off

Parental leave

Learning & Development

Job summary

Guidehealth is seeking a Remote Utilization Management RN to perform utilization review activities, document findings, and collaborate with medical leadership. The role emphasizes AI integration into daily workflow, regulatory compliance, and high-quality determinations across multiple jurisdictions.

The ideal candidate holds an Illinois RN license, offers at least three years of varied healthcare experience, and demonstrates strong communication and organizational skills.

Qualifications

• Registered Nurse with an active and unrestricted Illinois State License.
• Three years of experience in a variety of health care settings.
• Knowledge of utilization review, managed care, and community health.
• State licensure CE: 20 hours per 2-year renewal cycle.
• Strong organizational, writing, and speaking skills are necessary.
• Ability to prioritise and react to rapidly changing business needs.
• Excellent clinical judgment and compassion.

Responsibilities

• Perform timely utilization reviews including precertification and concurrent reviews using approved medical necessity criteria.
• Document clinical findings and determinations in accordance with standards.
• Communicate review determinations to providers, members, and required parties within established timeframes.
• Collaborate with Medical Director and Peer Reviewers on complex cases requiring review.

Skills

Utilization review

Clinical documentation

Communication skills

Organizational skills

Writing skills

Team collaboration

AI integration

Education

RN license

Tools

AI tools

Job description

Guidehealth is seeking a Remote Utilization Management RN to perform utilization review activities, document findings, and collaborate with medical leadership. The role emphasizes AI integration into daily workflow, regulatory compliance, and high-quality determinations across multiple jurisdictions.

The ideal candidate holds an Illinois RN license, offers at least three years of varied healthcare experience, and demonstrates strong communication and organizational skills.