Remote Utilization Management Specialist (RN/SW) – MT

Logan Health Medical Center; United States; Remote; USD 52,000 - 75,000; Full time

Benefits offered by this job

Four day work week

Affordable Medical Benefits package

401(k) with generous immediate match

Fitness Center Membership Discount

Supportive nursing culture

Fully remote opportunity in MT

Job summary

Logan Health Medical Center is seeking a Utilization Management Specialist to review admissions across the system and determine appropriate status. This role suits an RN or Social Worker with acute care experience, capable of collaborating with physicians, case management and insurers.

The position is fully remote for Montana residents and offers a four-day work week with competitive benefits. You will evaluate documentation, ensure medical necessity, and support timely care transitions while

Qualifications

• Current Montana RN license or multi-state compact license with Montana authority.
• Bachelor’s degree in Social Work; Associate’s degree required, Bachelor’s preferred.
• CCM certification preferred.
• Minimum five years’ acute care hospital experience; prior inpatient UM/patient status review preferred.
• Knowledge of Medicare/Medicaid UM regulations and denial management preferred.

Responsibilities

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

Skills

Attention to detail

Clinical judgment

Communication skills

Analytical thinking

Independent work

Collaboration

Education

Bachelor's degree in Social Work

Associate's degree in Social Work

Tools

EMR systems

Job description

Logan Health Medical Center is seeking a Utilization Management Specialist to review admissions across the system and determine appropriate status. This role suits an RN or Social Worker with acute care experience, capable of collaborating with physicians, case management and insurers.

The position is fully remote for Montana residents and offers a four-day work week with competitive benefits. You will evaluate documentation, ensure medical necessity, and support timely care transitions while