💼 About This Role

You'll apply clinical nursing expertise to evaluate medical necessity and coordinate care in a fully remote environment. You will directly impact patient outcomes by ensuring appropriate, timely care decisions. This role blends clinical judgment with health plan operations.

🎯 What You'll Do

• Apply clinical criteria to determine appropriateness of services and levels of care
• Coordinate with providers, members, and internal teams on care planning
• Document clinical assessments and utilization determinations accurately
• Support care coordination and escalate complex cases as needed

📋 Requirements

• Active Registered Nurse (RN) license in a compact state
• 3+ years of acute care experience (Med-Surg, Cardiac, Pulmonary, Critical Care)
• Ability to interpret medical records and clinical guidelines

✨ Nice to Have

• Experience in utilization management, health plan, Medicare, or Medicaid
• BSN or bachelor's degree in nursing or related field

🎁 Benefits & Perks

• 💰 Annual salary $71,100 - $97,800
• 🎯 Performance-based bonus incentive plan
• 🏥 Medical, dental, vision insurance
• 🏖️ Paid time off including holidays, parental leave, volunteer time
• 🏠 Remote work flexibility with home office support

📨 Hiring Process

Estimated timeline: 2-4 weeks · AI estimate

1. 1Application Screening· 1 week
2. 2Phone Interview· 30 min
3. 3Hiring Manager Interview· 45 min