Remote Utilization Review Clinician (RN) – Impact Healthcare

Premera; Washington; On-site; USD 80,000 - 126,000; Full time

Benefits offered by this job

Medical coverage

Vision coverage

Dental coverage

401K with match

Tuition assistance

Job summary

Premera is seeking a Telecommuter Utilization Review Clinician to evaluate clinical requests and determine medical necessity across inpatient, outpatient, and out-of-network scenarios. You will collaborate with Medical Directors and Care teams to ensure cost-effective, guideline-based care, following InterQual and internal policies.

The role requires RN licensure, a Bachelor's or equivalent experience, and 3+ years in clinical settings with utilization review exposure.

Qualifications

• Bachelor's degree or 4 years of work experience (Required).
• Current state RN licensure (Required).
• WA or Compact RN license (Preferred).
• 3 years of clinical experience (Required).
• Utilization Review experience (Preferred).
• Experience in the health plan industry (Preferred).

Responsibilities

• Conduct medical necessity reviews for inpatient, concurrent, and retrospective requests.
• Collaborate with Medical Directors and teams to support appropriate, cost-effective care.
• Document clinical information completely and on time; meet productivity and quality standards.

Skills

Clinical experience

Utilization Review

Healthcare knowledge

InterQual Guidelines

Education

RN licensure (state)

Bachelor's degree OR 4 years experience

Tools

InterQual Guidelines

Job description

Premera is seeking a Telecommuter Utilization Review Clinician to evaluate clinical requests and determine medical necessity across inpatient, outpatient, and out-of-network scenarios. You will collaborate with Medical Directors and Care teams to ensure cost-effective, guideline-based care, following InterQual and internal policies.

The role requires RN licensure, a Bachelor's or equivalent experience, and 3+ years in clinical settings with utilization review exposure.