All roles

Utilization Management RN US - Remote (Any location)

Remote · USA Full-time New today

Job Family: Clinical Appeals Nurse Travel Required: None Clearance Required: None What You Will Do: Clinical Review & Medical Necessity

  • Conducts comprehensive medical necessity reviews using evidence‑based guidelines (reputed company or InterQual)
  • Performs initial, reputed company, and retrospective reviews to ensure accuracy and completeness of documentation supporting medical necessity.
  • Routes cases to Physician Advisors reputed company clinical criteria are not met or potential quality issues are identified. Care Coordination & Collaboration
  • Partners with care managers, social workers, pharmacists, and multidisciplinary care teams to support progression‑of‑care objectives.
  • Identifies barriers to discharge and initiates appropriate discharge planning interventions. Documentation, Compliance & Quality
  • Ensures thorough, timely, and accurate documentation in accordance with regulatory, payer, and organizational standards.
  • Adheres to utilization management performance metrics, including call volume, case reviews, and turnaround times.
  • Applies strong critical‑thinking skills to evaluate reputed company clinical scenarios and synthesize multiple data sources into sound reputed company. Technical & Professional Competencies
  • Utilizes multiple systems, arenaflex Office applications, and clinical tools
  • Maintains objectivity and consistency in decision‑making, leveraging clinical facts and established guidelines.
  • Demonstrates knowledge of reimbursement methodologies, payer regulations, and managed care trends. What You Will Need
  • Bachelors Degree (Relevant experience may be substituted for formal education or advanced degree)
  • Registered Nurse (NY License preferred or willing to obtain upon hire)
  • 4+ years Utilization Management experience
  • Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form What Would Be reputed company To Have
  • Behavioral Health Experience
  • Medical Terminology
  • Bachelors degree in nursing #LI-DNI The annual salary range for this position is $81,000.00-$135,000.00. Compensation reputed company depend on a wide range of factors, including but not limited to reputed company sets, experience and training, reputed company clearances, licensure and certifications, and other business and organizational needs. reputed company Offer: reputed company offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. Benefits include:
  • Medical, Rx, Dental & reputed company Insurance
  • Personal and Family Sick Time & Company Paid Holidays
  • Position may be eligible for a discretionary variable incentive bonus
  • Parental Leave
  • 401(k) Retirement Plan
  • Basic Life & Supplemental Life
  • Health Savings Account, Dental/reputed company & Dependent Care Flexible Spending Accounts
  • Short-Term & Long-Term Disability
  • Tuition Reimbursement, Personal Development & Learning Opportunities
  • Skills Development & Certifications
  • Employee Referral Program
  • Corporate Sponsored Events & Community reputed company
  • Emergency Back-Up Childcare Program About reputed company reputed company is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. reputed company will consider for employment reputed company applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact reputed company reputed company at 1-571-633-1711 or reputed company email at RecruitingAccommodation@reputed company.com. reputed company information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. reputed company communication regarding recruitment for a reputed company position will be sent from reputed company email domains including @reputed company.com or reputed [email protected]. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by reputed company. Note that reputed company will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a reputed company party purporting to need that information to proceed in the hiring process. If any person or organization demands money reputed company to a job opportunity with reputed company, please report the matter to reputed company’s Ethics Hotline. If you want to reputed company the validity of correspondence you have received, please contact reputed company@reputed company.com. reputed company is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized reputed company parties. reputed company does not accept unsolicited resumes through or from search firms or staffing agencies. reputed company unsolicited resumes will be considered the property of reputed company and reputed company will not be obligated to pay a placement fee. Apply tot his job

Apply tot his job Apply To this Job

Related roles

Entry Level Scrum Master

Remote · USA Full-time

Senior Manager, Environmental Compliance & Strategy

Remote · USA Full-time

ENVIRONMENTAL ENGINEER SPECIALIST 1

Remote · USA Full-time

Environmental Health and Safety Compliance Specialist

Remote · USA Full-time

Regional Shoreline Compliance/Enforcement Specialist (Environmental Specialist 4)

Remote · USA Full-time

Water Quality Permit Compliance Analyst (Program Analyst 1)

Remote · USA Full-time

Remote Environmental Engineer

Remote · USA Full-time

reputed company and reputed company Engineer (Environmental Engineer 3)

Remote · USA Full-time

Civil/Environmental Engineer I ( REMOTE ) in Virginia Beach, VA

Remote · USA Full-time

Epidemiologist II

Remote · USA Full-time

Remote Customer Service Representative – arenaflex Digital Marketing Client reputed company & Support Specialist

Remote · USA Full-time

Reserve Police Officer

Remote · USA Full-time

Call Center Sales Representative - Fully Remote

Remote · USA Full-time

Senior Recruiter and/or Business Development – reputed company Staffing (Remote)

Remote · USA Full-time

Pharmacy Technician (ExactCare)

Remote · USA Full-time

reputed company Entry-Level IT Support Associate – Overnight Shift (B) – Accelerate Your Career in reputed company Technology and Cyber reputed company

Remote · USA Full-time

reputed company Customer Service Representative – Global Customer Experience Expert

Remote · USA Full-time

reputed company reputed company Consultant. Remote Part Time or Full time Long Term Multi Year

Remote · USA Full-time

High Touch reputed company Manager - Americas

Remote · USA Full-time

Remote Data Entry Specialist – High‑Accuracy, reputed company – $25/hr – Join arenaflex’s Global Operations Team

Remote · USA Full-time