Clinical Care Manager - Utilization Review Nurse - Remote

Overview

Guidehealth is seeking a Clinical Care Manager who is passionate about advancing high-quality, compliant, patient-centered care through precise and timely Utilization Review.

In Short

• Conduct timely reviews of healthcare services.
• Document clinical findings in accordance with regulations.
• Communicate review decisions to required parties.
• Collaborate with Medical Directors and Peer Reviewers.
• Identify and refer members to disease management programs.
• Maintain confidentiality of member information.
• Participate in quality management initiatives.
• Prepare benefit exhaustion letters upon request.
• Maintain knowledge of relevant regulations and standards.
• Support ongoing professional education and growth.

Requirements

• Active, unrestricted RN license in Illinois.
• 5+ years of experience in healthcare settings.
• Knowledge of utilization review and managed care processes.
• Strong proficiency in Microsoft 365.
• Excellent written and verbal communication skills.
• Ability to prioritize effectively.
• Strong clinical judgment and compassion.

Benefits

• Fully remote work environment.
• Comprehensive Medical, Dental, and Vision plans.
• 401(k) plan with employer match.
• Life and Disability insurance.
• Employee Assistance Program (EAP).
• Paid time off plans.
• Paid parental leave.
• Resources for professional growth and development.