Remote Utilization Review RN | InterQual/UM Expert

Community Health Network, Inc.; Boston (MA); Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Full benefits

401K

Job summary

Community Health Network is seeking an experienced RN Case Manager with Utilization Review/UR expertise for a remote-based position. The role requires active MA RN licensure with UR/UM and InterQual experience in a managed care setting, focusing on inpatient utilization and discharge planning.

The position offers 40 hours per week, Monday–Friday, with some after-hours as needed, a contract arrangement, and a full benefits package including health, dental, vision, life insurance and 401K.

Qualifications

• Active MA RN license required; compact license may be possible for other plans.
• Experience with Utilization Review (UR) and InterQual criteria is required.
• Knowledge of managed care and discharge planning is essential.

Responsibilities

• Perform utilization management activities for hospital inpatients.
• Apply industry standards and plan-specific criteria to determine appropriateness of inpatient care.
• Collaborate with healthcare team to support discharge planning and member outcomes.

Skills

Utilization Review (UR) experience

InterQual

Managed care

Discharge planning

Education

MA RN license

Job description

Community Health Network is seeking an experienced RN Case Manager with Utilization Review/UR expertise for a remote-based position. The role requires active MA RN licensure with UR/UM and InterQual experience in a managed care setting, focusing on inpatient utilization and discharge planning.

The position offers 40 hours per week, Monday–Friday, with some after-hours as needed, a contract arrangement, and a full benefits package including health, dental, vision, life insurance and 401K.