Utilization Management RN (Compact Licensed)
$70k/y-$100k/y
Clearlink Partners2 days ago
Highlight
OnsiteFull-timeSenior
Summary
Clearlink Partners is seeking a Utilization Management RN (Compact Licensed) to join their team in the United States. The role involves determining the appropriateness of services through the application of medical guidelines and collaborating with medical directors for complex cases.
About the Role
As a Utilization Management RN, you will perform reviews of inpatient admissions, outpatient surgeries, and ancillary services, ensuring compliance with medical guidelines. You will document review determinations, advocate for cost-effective treatment plans, and work with vulnerable populations to ensure access to care. Your responsibilities will also include expediting care processes and collaborating across the healthcare spectrum to improve quality outcomes.
About You
Required:
- Current unencumbered Compact RN license.
- Minimum of 5+ years of acute clinical experience.
- Minimum 2 years’ experience in a managed care environment across multiple lines of business.
Preferred:
- HMO and risk contracting experience.
- In-depth knowledge of current standard of medical practices and insurance benefit structures.
- Proficiency in Microsoft Office.
Benefits
- Competitive salary range of $70k–$100k.
- Full-time employment with Monday to Friday work schedule.
- Opportunity to work with low-income and vulnerable populations.
Clearlink Partners
Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities. We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity. Clearlink Partners is a Health Plan Alliance Preferred Business Sponsor and ACAP Preferred Vendor.
United States