Remote Utilization Management Specialist - RN or MSW

Logan Health; Montana; Remote; USD 52,000 - 75,000; Full time

Benefits offered by this job

Four day work week

Affordable medical benefits

401(k) with matching

Fitness center membership discount

Supportive nursing culture

Job summary

Logan Health is hiring a Utilization Management Specialist to join the UM team. The role focuses on reviewing admissions, validating documentation and determining appropriate admission status across the hospital system.

You will collaborate with physicians, case management and insurers to authorize care and ensure medical necessity. The position emphasizes strong clinical judgment, communication and EMR proficiency, with a four-day work week and remote options for Montana residents.

Qualifications

• Montana RN license or multi-state compact with MT authorization.
• Bachelor's degree in Social Work; Associate degree required; Bachelor’s preferred.
• CCM certification preferred.
• Minimum of five (5) years’ acute care hospital experience.
• Prior inpatient utilization review or UM experience preferred.
• Knowledge of Medicare/Medicaid UM regulations and Denial Management preferred.
• Excellent interpersonal, written and verbal communication skills.

Responsibilities

• Review daily inpatient and observation admissions across the Logan Health system.
• Evaluate physician documentation and patient data to determine admission status.
• Reassess patients to ensure continued criteria for level of care.
• Collaborate with UM Advisor, case management and insurers to facilitate authorizations.
• Schedule and coordinate peer-to-peer physician reviews.
• Communicate with providers and staff to ensure accurate documentation and smooth transitions.
• Identify issues delaying reviews or affecting compliance.
• Utilize EMR to support documentation, reviews and reporting.
• Work independently while collaborating with the interdisciplinary team.

Skills

Acute care experience

Communication skills

Clinical judgment

Education

RN license MT or multi-state compact

Bachelor's in Social Work

Associate degree

CCM certification

Tools

EMR systems

Job description

Logan Health is hiring a Utilization Management Specialist to join the UM team. The role focuses on reviewing admissions, validating documentation and determining appropriate admission status across the hospital system.

You will collaborate with physicians, case management and insurers to authorize care and ensure medical necessity. The position emphasizes strong clinical judgment, communication and EMR proficiency, with a four-day work week and remote options for Montana residents.