Telephonic Utilization Management & Case Management Operations Registered Nurse | Remote

EXL Service; Birmingham (AL); Remote; USD 75,000 - 90,000; Full time

Job summary

An established industry player in healthcare analytics is seeking a dedicated Utilization Management & Complex Case Nurse to join their remote team. This role involves reviewing authorization requests and performing comprehensive case management to ensure quality, cost-effective care. You will collaborate with multidisciplinary teams and leverage your clinical expertise to optimize healthcare outcomes. With a focus on innovation and technology, this position offers a unique opportunity to make a significant impact in the healthcare sector. If you're passionate about improving patient care and thrive in a dynamic environment, this role is perfect for you.

Qualifications

• Unrestricted RN license in residence, multi-state preferred.
• 3+ years clinical nursing experience and 2+ years utilization review.

Responsibilities

• Review authorization requests for medical necessity.
• Develop and document care plans, coordinate activities.

Skills

Clinical Nursing Experience

Utilization Review

Case Management

MS Office Proficiency

Telephonic Outreach

Education

Bachelor's in Nursing

Tools

MS Office

Teams

SharePoint

Job description

Telephonic Utilization Management & Case Management Operations Registered Nurse | Remote

Location Options:

• Albuquerque, NM, USA
• Atlanta, GA, USA
• Austin, TX, USA
• Birmingham, AL, USA
• Bozeman, MT, USA
• Cedar Rapids, IA, USA
• Dallas, TX, USA
• Denver, CO, USA
• Fargo, ND, USA
• Houston, TX, USA
• Indianapolis, IN, USA
• Kalispell, MT, USA
• Kansas City, KS, USA
• Little Rock, AR, USA
• Louisville, KY, USA
• Memphis, TN, USA
• Minneapolis, MN, USA
• Missoula, MT, USA
• Nashville, TN, USA
• New Orleans, LA, USA
• Oklahoma City, OK, USA
• Omaha, NE, USA
• Phoenix, AZ, USA
• Pocatello, ID, USA
• Salt Lake City, UT, USA
• Sioux Falls, SD, USA
• St. Louis, MO, USA
• United States (Remote)

Company Overview:

EXL (NASDAQ: EXLS) is a leading data analytics and digital operations company, partnering with clients to reinvent business models using data and AI to drive outcomes. Founded in 1999 and headquartered in New York, EXL employs over 55,000 people worldwide.

About EXL Health:

We leverage human ingenuity and domain expertise to improve healthcare outcomes, optimize revenue, and maximize profitability. Our solutions are technology, data, and analytics-driven, working across the healthcare ecosystem to transform care delivery, management, and payment.

Position: Utilization Management & Complex Case Nurse | Remote

Join us to review authorization requests, perform comprehensive case management, and support beneficiaries with complex conditions through telephonic and digital outreach. Our goal is to ensure quality, cost-effective care that promotes improved health and functional capabilities.

Responsibilities include:

1. Review authorization requests for medical necessity and appropriate care levels.
2. Assess services for outcomes, cost-effectiveness, and compliance.
3. Identify benefits and eligibility, conduct reviews, and collaborate with stakeholders.
4. Develop and document care plans, coordinate activities, and monitor progress.
5. Collaborate with multidisciplinary teams and adhere to policies and regulations.

Work Schedule:

Monday - Friday, 8-hour shifts aligned to your time zone (PT, MT, CT, ET).

Qualifications:

Required:

• Unrestricted RN license in residence (multi-state privileges preferred).
• 3+ years clinical nursing experience.
• 2+ years utilization review experience.
• 1+ year case management experience.
• Proficiency with MS Office, Teams, SharePoint.
• US Citizenship and ability to obtain Security Clearance.
• Private home office environment.

Preferred:

• Bachelor’s in Nursing.
• Experience with NCQA, URAC, InterQual, MCG guidelines.
• Health plan and federal program experience.
• Active CCM certification.
• Remote work experience.

Additional Information:

Salary range: $75,000 - $90,000, with bonuses and benefits. Apply now to join our team and contribute to impactful healthcare solutions.