Utilization Management Nurse

Use clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations. Interpret criteria and procedures to determine appropriate care and treatment for members, and coordinate with providers to facilitate optimal outcomes. Work assignments are varied and frequently require independent judgment and interpretation in occasionally ambiguous situations, with guidance available where needed.

Schedule: Minimum 8 hours between 8:00 AM and 5:00 PM Eastern Time. Rotating holidays or weekends may be required based on business needs. Travel less than 5% for occasional onsite market meetings.

Required: Active RN license in Virginia or a compact (eNLC) state with no disciplinary action; at least 2 years of utilization management experience, preferably in acute care, skilled, rehabilitation, or health plan/hospital settings; intermediate to advanced Microsoft Office skills and ability to troubleshoot in a remote environment; strong independent and team-based work skills.

Preferred: BSN; experience with MCG/InterQual; Medicare/Medicaid or health plan experience.

Compensation: $71,100–$97,800 per year, plus eligibility for a bonus incentive plan.