Remote Nursing Jobs • Utilization Management

As an Evergreen Compassionate Care Nurse Care Manager, you will manage the healthcare journey of patients, perform assessments, and advance care planning conversations to identify their needs. You will collaborate with a team of Physicians, Advanced Practice Providers, and interdisciplinary team members. The role involves acting as a clinical liaison and educator, providing resources and training internally and externally.

The UM Nurse Specialist conducts clinical reviews to ensure that services provided to members meet clinical criteria and are delivered in appropriate settings, coordinating all aspects of utilization and benefit management. They validate medical documentation, consult with medical directors, and identify members for case management, also conducting retrospective medical claims audits.