Behavioral Health Utilization Management Registered Nurse

Location: Remote within the United States. The role may require working across multiple time zones in a hybrid or remote environment and occasional travel based on company needs.

Annual base salary: $65,000–$85,000.

Company

hirify.global provides AI-powered operational infrastructure and software for health insurance companies.

What you will do

• Coordinate and deliver telephonic clinical behavioral health services supporting member wellness and recovery.
• Perform prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory, and ancillary services.
• Assess medical necessity, length of stay, intensity of service, and level of care using approved clinical protocols.
• Research and respond to authorization requests, retrospective reviews, provider and member appeals, and benefit-related issues.
• Coordinate discharge planning and care across providers, facilities, members, and internal teams.
• Educate providers on policies, procedures, benefits, and utilization management programs.

Requirements

• Current unrestricted Registered Nurse license required.
• At least 2 years of acute clinical RN experience.
• At least 1 year of behavioral health clinical experience.
• At least 1 year of managed care or utilization management experience.
• Strong written and verbal communication, customer service, and interpersonal skills.
• Knowledge of clinical criteria, medical necessity standards, benefits, community resources, accreditation standards, and applicable regulations.

Nice to have

• Health insurance plan or managed care experience.
• Case Management certification or progress toward certification.

Culture & Benefits

• Full-time, permanent employment in an exempt position.
• Remote work environment with collaboration across multiple time zones.
• Use of video technology and computer-based clinical workflows.
• Reasonable accommodations are available in accordance with the Americans with Disabilities Act.