Managing the Utilization Management process, the full-time remote Utilization Management Nurse, RN will ensure appropriate and cost-effective healthcare delivery by conducting reviews, collaborating with healthcare professionals, and promoting quality care for plan participants. Key responsibilities Conduct timely reviews of UM activities, including prospective, concurrent, and retrospective assessments Collaborate with internal teams and healthcare providers to apply UM criteria and promote cost-effective outcomes Ensure compliance with regulatory standards and maintain accurate records of UM activities while safeguarding confidentiality Required qualifications 3+ years of clinical nursing experience Active, unrestricted RN license in the state of residence Experience in a fast-paced, detailed, and deadline-driven environment Ability to maintain confidentiality and handle sensitive information Strong problem-solving and organization skills