RN Utilization Review Care Manager

Job not on LinkedIn

🔥 3 hours ago

⛰️ Colorado – Remote

⛰️ Colorado – Remote

💵 $41 - $62 / hour

⏱ Part Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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IMH

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2007

🏗️ Construction

📦 Logistics

🛡️ Insurance

Construction • Logistics • Insurance

IMH is the Groupe IMA entity providing end-to-end housing assistance and post-claim services across France. It operates 24/7 emergency call-taking and rapid-response interventions for home incidents (fires, water damage, electrical faults, locksmithing), offers remote damage expertise and cost estimation, and manages repair-in-kind through a national network of vetted contractors. IMH also runs digital platforms to support project estimation and paid home-service offerings, coordinates large-scale catastrophe responses, and connects insurers, beneficiaries and service providers via its accredited prestataire network.

📋 Description

• Perform utilization review care management screenings, assessments, and evaluations • Develop and implement plans promoting cost-effective, high-quality care • Review and investigate medical records to assess benefit utilization and medical necessity • Apply evidence-based guidelines such as InterQual and MCG and medical policies for prior authorization and post-service reviews • Follow NCQA, CMS, state, and plan regulatory guidelines • Communicate clearly and accurately with members, providers, and internal and external partners • Engage providers to support safe, efficient care, appropriate care settings, and transitions of care • Collaborate with physicians, staff, members, and families to expedite authorizations and direct patients to medically necessary care and appropriate service settings • Resolve queries regarding authorizations, treatment plans, and medical necessity determinations • Mentor and guide UM LPN and non-clinical staff on processes, clinical questions, and resource application • Provide enterprise-wide shift coverage for Peaks, Canyons, and Desert regions • Work an average of two days per week, including two weekends per eight-week schedule and holiday coverage • Work 8:00 AM–5:00 PM

🎯 Requirements

• Current Registered Nurse (RN) license in state of practice and compact licensure within service area • Bachelor of Science in Nursing (BSN) from an accredited institution; degree verification required • RNs hired or promoted into this role must obtain their BSN within four (4) years of hire or promotion date • Demonstrated experience in care management/navigation or a closely related field, including Utilization Management, discharge planning, managed care, health promotion, health coaching, behavioral health, or Patient Educator roles • Demonstrated clinical nursing experience in an inpatient hospital setting • Familiarity with hospital patient-related terminology and processes • Understanding of disease management, including treatment, length of stay, barriers to delivery of care, and variations • Strong written and verbal communication and conflict resolution skills • Basic computer hardware setup and ability to customize computer settings, use multiple monitors, and independently troubleshoot internet and applications • Knowledge of Microsoft Office software • Ability to work independently, be self-motivated, maintain a positive attitude, and remain flexible in a rapidly changing environment • Candidates must not reside or plan to reside in California, Connecticut, Hawaii, Illinois, Massachusetts, Maine, Minnesota, New York, Pennsylvania, Rhode Island, Virginia, Vermont, or Washington • Video interview through Microsoft Teams required

🏖️ Benefits

• Generous benefits package covering programs supporting wellness, security, connection, and engagement • Remote work options and company equipment expectations for approved remote roles

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