Remote RN: Utilization Management & Care Quality

Arkansas Blue Cross Blue Shield is seeking a licensed RN to perform clinical review of prior approvals, network exceptions, and medical necessity determinations for inpatient and outpatient services. You will interpret criteria and collaborate with providers to promote quality care and cost containment.

The role enables remote work from home across several states, requiring strong communication, critical thinking, and ability to navigate multiple systems while maintaining compliance with URAC