Remote Clinical Utilization Manager
About The Position
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Utilization Management Specialist - REMOTE. In this role, you will leverage your clinical expertise to significantly influence patient outcomes through effective utilization management practices. This position involves reviewing patient admissions and collaborating with multidisciplinary teams to ensure appropriate admission status. You will utilize your exceptional communication and analytical skills to navigate the complexities of health care support processes effectively. Join us in making a positive impact on health care delivery while working from the comfort of your home. Accountabilities Review daily inpatient and observation admissions across the system. Evaluate physician documentation and patient data to determine admission status. Reassess patient care levels throughout their stay. Collaborate with interdisciplinary teams for authorizations and medical necessity reviews. Assist with scheduling peer-to-peer physician reviews. Communicate effectively with providers and stakeholders. Identify compliance or review delays and address them promptly. Utilize electronic medical records for documentation and reporting. Requirements Current RN license in Montana or multi-state compact license. Bachelor's or Master's degree in Social Work or relevant field. Minimum five years of acute care hospital experience. Prior experience in inpatient utilization review preferred. Knowledge of Medicare and Medicaid regulations. Strong interpersonal communication and analytical skills. Detail-oriented with the ability to manage multiple priorities. Benefits Four-day work week with flexible scheduling. Affordable medical benefits package. 401(k) with generous employer match. Discounted fitness center membership. Supportive and mission-driven work culture. Why Apply Through Jobgether? We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1 We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
Requirements
- Current RN license in Montana or multi-state compact license.
- Bachelor's or Master's degree in Social Work or relevant field.
- Minimum five years of acute care hospital experience.
- Knowledge of Medicare and Medicaid regulations.
- Strong interpersonal communication and analytical skills.
- Detail-oriented with the ability to manage multiple priorities.
Nice To Haves
- Prior experience in inpatient utilization review preferred.
Responsibilities
- Review daily inpatient and observation admissions across the system.
- Evaluate physician documentation and patient data to determine admission status.
- Reassess patient care levels throughout their stay.
- Collaborate with interdisciplinary teams for authorizations and medical necessity reviews.
- Assist with scheduling peer-to-peer physician reviews.
- Communicate effectively with providers and stakeholders.
- Identify compliance or review delays and address them promptly.
- Utilize electronic medical records for documentation and reporting.
Benefits
- Four-day work week with flexible scheduling.
- Affordable medical benefits package.
- 401(k) with generous employer match.
- Discounted fitness center membership.
- Supportive and mission-driven work culture.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
