Utilization Management Nurse – Physical Health

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

📋 Description

• Perform prospective, concurrent, and retrospective clinical evaluations utilizing established criteria.

• Analyze clinical data to assess medical necessity and appropriate level of care.

• Work collaboratively with providers and facilities to facilitate treatment planning and discharge coordination.

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

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

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

• Assess clinical information and assist in discharge planning to enhance outcomes and continuity of care.

⛳️ Requirements

• An Associate's degree in Nursing is required.

• 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 the use of evidence-based clinical decision support tools.

• Must possess an active North Carolina Licensure as a Registered Nurse (RN).

• A valid driver’s license is necessary.

• Candidates must reside in North Carolina.

• Ability to travel within the catchment area as needed.

• Preferred: Experience as a Physical Health Utilization Management Reviewer within a health plan.

• Preferred: Clinical background in a managed care organization, health plan, or hospital environment.

• Preferred: Certification in Utilization Management.

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

• Resumes should detail employer names, dates of service, average weekly hours worked, key job responsibilities, educational background, and licensure/certification details.

🏝️ Benefits

• A collaborative and mission-driven work atmosphere.

• Competitive benefits package and work-from-home options available for most roles.

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

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

• Health insurance with no premium cost for employee coverage.

• Flexible Spending Accounts available.

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

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

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

• Employer qualified for Public Service Loan Forgiveness (PSLF).

• Quarterly stipend provided for remote work supplies.