Job Title: Utilization Review RN
Location: 100% REMOTE
About the Role:
We are seeking a skilled Utilization Review RN to join our team. In this role, you will leverage your clinical expertise to assess, plan, implement, and evaluate health care services aligned with physician treatment plans. You will play a key role in ensuring quality, cost-effective care while supporting optimal healthcare outcomes for members.
Key Responsibilities:
• Deliver delegated tasks independently within the Nurse Case Management team.
• Assess, plan, implement, coordinate, monitor, and evaluate healthcare services to support member outcomes.
• Ensure case management program objectives are achieved through effective evaluation of alternative care services.
• Provide clinical assessments, health education, and utilization management to members.
• Perform prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services.
• Manage an independent caseload and coordinate all assigned cases effectively.
• Anticipate needs, plan proactively, and resolve escalated non-routine issues.
• Collaborate with physicians, healthcare providers, and internal teams to ensure quality care delivery.
Qualifications:
• Registered Nurse (RN) with current, unrestricted nursing license (required).
• Strong clinical knowledge with experience in case management.
• Utilization review experience required
EEO:
Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.
