RN - Utilization Management Senior Analyst

We are seeking a dedicated and experienced RNs with Utlization management experience to join our healthcare team. 100% Remote *****MUST HAVE RN license in one of the following states: IL, TX, NM, OK, MT, TN**** The ideal candidate will play a critical role in coordinating patient care, ensuring that individuals receive the necessary services and support throughout their healthcare journey.

Delivers specific delegated tasks assigned by a supervisor in the Nurse Case Management job family. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Provides clinical assessments, health education, and utilization management to members. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. Manages own caseload and coordinates all assigned cases. Completes day-to-day Nurse Case Management tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members.