Utilization Management Case Manager

Utilization Management Case Manager – 3 month contract w/ potential to extend and convert!!Join our client’s team as a vital contributor to high-quality healthcare management. As a Utilization Management Case Manager, you'll play a pivotal role in evaluating medical requests, ensuring appropriate care, and supporting efficient decision-making within a dynamic, fully remote environment. This opportunity offers a competitive salary with flexible work hours, allowing you to make a meaningful impact while maintaining a healthy work-life balance.Compensation: $45-50/hrOnsite Requirements: Fully remoteSchedule: Saturday – Wednesday, 40 hrs/wkResponsibilities• Conduct prospective, concurrent, and retrospective clinical reviews utilizing InterQual® criteria, organizational policies, and physician input as necessary across various lines of business.• Analyze and process authorization requests for medical services, making determinations about eligibility, medical necessity, and coverage, while identifying additional information needs.• Manage incoming requests for procedures and services, including reviewing medical records and related clinical documentation for accuracy and completeness.• Collaborate effectively with internal teams and external providers to ensure smooth case progression and resolution.• Track and meet departmental performance metrics, including productivity targets.• Maintain thorough documentation of case reviews and decisions within organizational systems.• Be available to provide on-call review support approximately once per month, with potential increases based on staffing needs.Requirements• Valid RN degree with 1-2 years of utilization review experience in a managed care setting.• Demonstrated ability to review 25-30 cases per day using InterQual® criteria and other clinical resources.• Prior authorization experience, particularly outpatient review and Medicaid/MassHealth knowledge.• Strong understanding of commercial, self-insured, fully insured, and limited network plan types.• Exceptional verbal and written communication skills, with the ability to problem-solve and deliver excellent customer service.• Ability to work independently in a remote setting with minimal supervision.• Proficiency in Microsoft Office Suite (Word, Excel, Outlook), SharePoint, and McKesson InterQual®.• Flexibility to work Saturday through Wednesday, with 40 hours per week.Preferred Education and Experience• RN license with over 5 years of nursing experience, ideally including critical care or emergency department backgrounds.• Experience handling complex cases in a managed care or hospital environment.Other Requirements• Ability to work remotely with provided equipment.• Willingness to participate in virtual interviews with management.• Availability for potential on-call shifts and the ability to adapt to evolving departmental needs.Elevate your healthcare career with this rewarding opportunity—apply today to become a key part of a dedicated team committed to outstanding patient care!Our Commitment to Inclusion & BelongingThe Hollister Group is an equal opportunity employer. We welcome and encourage applications from people who are under-represented in their respective occupation or position.#HGP#LI-KM1