Utilization Management Nurse – Physical Health

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Carry out prospective, concurrent, and retrospective clinical reviews utilizing established criteria.

• Evaluate clinical information to establish medical necessity and the appropriate level of care.

• Work in collaboration with providers and facilities to enhance treatment planning and facilitate discharge coordination.

• Conduct admission and concurrent reviews to oversee ongoing care requirements.

• Recognize cases that necessitate physician review and provide clinical recommendations.

• Coordinate care to guarantee the appropriate use of services and effective transitions in care.

• Assist in discharge planning to enhance outcomes and ensure continuity of care.

⛳️ Requirements

• An Associate's degree in Nursing.

• A minimum of two (2) years of experience in Utilization Management/Review, including clinical acute inpatient care (ER, ICU, Med-Surg), behavioral health, compliance, or evidence-based clinical decision support tools.

• Active North Carolina Licensure as a Registered Nurse (RN).

• A valid driver's license is required.

• Candidates must reside within North Carolina.

• Ability to travel within the designated catchment area as needed.

• Clinical experience in a managed care organization, health plan, or hospital environment is preferred.

• Utilization Management certification is preferred.

• All applicants must successfully pass a drug test as a condition of employment.

🏝️ Benefits

• A collaborative, mission-focused work environment.

• Competitive benefits and remote work options available for most roles.

• Opportunities for professional development within a diverse and inclusive culture.

• Flexible work schedules available, subject to management approval for certain positions.

• Work-from-home options accessible for the majority of roles.

• Comprehensive Health Insurance with no premium cost for employee coverage.

• Flexible Spending Accounts.

• 24 days of Paid Time Off (PTO) along with 12 paid holidays during your first year.

• NC Local Government Retirement Pension (defined-benefit plan).

• 401k plan with a 5% employer match and immediate vesting.

• Qualifying employer for Public Service Loan Forgiveness (PSLF).

• Quarterly stipend provided for remote work supplies.