Utilization Management RN

HealthCare Strategies

. Collect personal and clinical information on participating Plan members .

Posted 11/11/2026part-timeRemote • United StatesJunior💰 $34 - $38 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical assessments, patient education, and medical necessity reviews while adhering to confidentiality policies. Proficient in utilizing InterQual criteria and Microsoft Office Suite to support effective communication and decision-making in a healthcare setting.

Highest-signal resume keywords

Active RN Compact LicenseClinical AssessmentsInterQual Criteria ExperienceMedical Necessity ReviewsVerbal Communication Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical Information CollectionTelephonic AssessmentsMedical Appropriateness DeterminationCase Management IdentificationDocumentation AccuracyPrior Authorization DeterminationProblem-Solving SkillsDecision-Making SkillsDetailed Instruction ExecutionUM Experience

Soft Skills

Strong Verbal Communication Skills

Tools & Technologies

Microsoft Office Suite

Certifications & Qualifications

Active RN Compact License

Industry Keywords

Patient EducationHealthcare Providers CommunicationConfidentiality PoliciesCommunity ServicesInpatient and Outpatient Services

About the role

Key responsibilities & impact

Collect personal and clinical information on participating Plan members
Provide patient education services
Render initial determinations of medical appropriateness for communication to the health benefit plan
Identify individuals whose health and/or expenses may be positively affected through Large Case Management
Perform telephonic clinical assessments
Obtain information from healthcare providers, patients, or families regarding planned procedures, admissions, continued stays, or discharge plans
Interpret nationally recognized criteria to support recommendations for inpatient and outpatient services
Identify and refer individuals for Case Management
Document calls completely, accurately, and promptly in the computer system
Follow policies and procedures for confidential materials and patient-specific information
Answer calls related to medical services and determine whether prior authorization is required
Retrieve and acknowledge voicemail messages requesting medical services
Complete medical necessity reviews and communicate outcomes to providers within appropriate time frames
Provide educational materials and direct callers to community services when indicated
Provide coverage for professional colleagues

Requirements

What you’ll need

Active, unrestricted RN Compact License
Minimum internet speeds of 25Mbps download and 25 Mbps upload
1+ years experience in hospital setting
Strong verbal communication skills
Problem-solving and decision-making skills
Ability to carry out detailed written or verbal instructions independently
Proficiency with Microsoft Office Suite (Outlook, Word)
1+ years previous UM experience (preferred)
Experience using InterQual criteria (preferred)

Benefits

Comp & perks

Work from your home office
Part-time schedule of 20 to 25 hours per week
Monday–Friday schedule
Core office hours of 9am–6pm ET
Coverage for professional colleagues