RN- Utilization Management Nurse

I’m helping

LanceSoft

find a top candidate to join their team

full-time

for the role of

RN- Utilization Management Nurse

.

You'll shape behavioral health outcomes by applying clinical expertise to vital utilization management.

Compensation:

USD 35 - 40/hour

Location:

Remote: United States

Mission of LanceSoft:

"LanceSoft’s mission is to establish global cross-culture human connections that further the careers of our employees and strengthens the businesses of our clients. We are driven to use the power of our global network to connect businesses with the right people, and people with the right businesses without bias. We provide Global Workforce Solutions with a human touch."

What makes you a strong candidate:

• You are proficient in Utilization management, Prior authorization, Long term care, Discharge planning, Case management.
• You have the potential to develop in Insurance utilization management.
• English - Conversational

Responsibilities and more:

Job Title: RN- Utilization Management Nurse

Duration: 4 plus month with possible Extension

Location- Remote/Telehealth

Pay Range: $35\.00- $40\.00/hr

Top 2 Skills

1\. Behavioral Health Utilization Management

Ability to review clinical information, apply medical necessity guidelines, and make UM decisions (initial, concurrent, and discharge planning).

Includes strong discharge planning skills to support safe, appropriate transitions of care.

2\. Clinical Assessment \& Critical Thinking

Skilled in evaluating clinical needs, reviewing records, and making sound decisions that balance quality, cost, and member-centered care.

Must have a strong understanding of community behavioral health resources to support referrals and continuity of care.

The Utilization Management Clinical Consultant (UMCC) applies clinical expertise and evidence-based criteria to assess the medical necessity, appropriateness, and quality of behavioral health services for adult and child/adolescent members.

This role supports appropriate utilization of benefits across the continuum of care through collaboration, clinical review, and stakeholder communication.

Review clinical information and apply medical necessity criteria, clinical guidelines, policies, and professional judgment to render coverage determinations and discharge planning decisions.

M-F 8am-5pm AZ time

Fully remote (never coming onsite)