Utilization Review RN

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 (CHN) has been placing experienced nurses and therapists in home care, hospice, and case management for over 30 years. We offer flexible work options and outside-of-the-box opportunities that focus on your needs and interests. Community Health Network has been asked to assist a top health plan partner of ours with a need for an experienced RN Case Manager with Utilization Review/UM experience. This position is remote based and requires an activeMA RN license. (Compact RN license may be possible for other plans) Working for a health plan the Utilization Review RN will provide a range of utilization management activities for members in an inpatient setting. Candidates MUST have current UM/UR and InterQual experience, managed care, and discharge planning experience to be considered. Utilize industry standards / plan proprietary criteria for determining the appropriateness of the inpatient setting.

Job Summary:

• Monday-Friday (some after hours and/ or weekend work may be required)
• 40 hours/week
• Contract
• Competitive payrates
• Full benefits package including health, dental, vision, life and 401K
• Work from home, remote based position

Why Choose CHN?

• Flexible work options
• Benefits that include health, dental, vision, life insurance and 401k
• Supportive team focused on your needs and interests