Remote Utilization Review RN - Care Coordinator

Evry Healthcare Inc.; Dallas, Northern (TX, KY); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Competitive salary

Health, dental, vision insurance

Retirement plan with company match

Generous paid time off

Job summary

Evry Health is seeking an RN Integrated Care Coordinator (UM) to provide comprehensive care coordination and drive quality outcomes across the care continuum. The role requires posting to physicians and working with members, providers, and facilities to ensure high-quality care in a remote environment, with rotating weekend utilization review coverage.

The candidate should have 1–2 years in utilization management, 3–5 years clinical experience, and a current Texas nursing license along with

Qualifications

• Healthcare and managed care appeals experience.
• Current unrestricted Texas nursing license; include license number.
• Diploma from an accredited nursing program.
• 1–2 years in utilization management; 3–5 years clinical care experience.

Responsibilities

• Prepare clinical reviews based on guidelines for physician review.
• Conduct pre-auth, concurrent, and retrospective reviews.
• Monitor quality concerns and escalate care issues promptly.
• Interact with facilities/providers to gather information for medical necessity.
• Assist with coding, medical records, pre-certification, and denials/appeals.
• Support discharge planning and care coordination in a remote setting.

Skills

Healthcare experience

Active RN license

Utilization management

Telephonic outreach

Remote work capability

Education

Nursing diploma

Tools

Salesforce

HealthCloud

CareIQ

Job description

Evry Health is seeking an RN Integrated Care Coordinator (UM) to provide comprehensive care coordination and drive quality outcomes across the care continuum. The role requires posting to physicians and working with members, providers, and facilities to ensure high-quality care in a remote environment, with rotating weekend utilization review coverage.

The candidate should have 1–2 years in utilization management, 3–5 years clinical experience, and a current Texas nursing license along with