Utilization Management RN

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $65k - $68k / year

⏰ Full Time

🟢 Junior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

HealthCare Strategies

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

HealthCare Strategies is a medical cost-management company that provides predictive care management, virtual nursing and outreach, and medical management services to reduce plan costs and improve member outcomes. It serves self-insured employers, labor funds and coalitions, third-party administrators (TPAs), government and commercial health plans, and provider groups. HCS uses AI-driven analytics and a consumer health platform to identify emerging health risks earlier, connects members with care managers and virtual nurses, and offers utilization management, precertification, case review, and independent review services. The company emphasizes measurable improvements in health outcomes and cost reductions and is based in Columbia, MD.

📋 Description

• Collect personal and clinical information on participating Plan members • Provide patient education services • Render initial determinations of medical appropriateness for communication to the health benefit plan • Identify individuals whose health and/or expenses may be positively affected through application of Large Case Management • Perform telephonic Clinical Assessments • Obtain information from health care providers, patients, or families regarding planned procedures, admissions, continued stays, or discharge plans • Interpret nationally recognized criteria to support recommendations for inpatient and outpatient services • Identify and refer individuals for Case Management • Document each call completely, accurately, and promptly in the computer system • Follow policies and procedures for confidential materials and patient-specific information • Answer direct telephone calls to determine whether prior authorization is required • Retrieve and acknowledge voicemail messages requesting medical services • Complete medical necessity reviews and communicate outcomes to providers within appropriate time frames • Provide educational materials and direct callers to community services when indicated • Provide coverage for professional colleagues

🎯 Requirements

• Active, unrestricted RN License • Minimum internet speeds of 25Mbps download and 25 Mbps upload • 1+ years experience in hospital setting • Strong verbal communication skills • Problem-solving and decision-making skills • Ability to carry out detailed written or verbal instructions independently • Proficiency with Microsoft Office Suite (Outlook, Word) • Preferred: 1+ years previous UM experience • Preferred: Experience using Interqual criteria

🏖️ Benefits

• Work from the comfort of your own home • Monday-Friday schedule • 40-hour work week

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume