Utilization Management Nurse, US – (Remote)

About the Role

The Utilization Management Nurse at Curana Health is a remote telephonic position focused on reviewing and monitoring members' healthcare service utilization to ensure high-quality, cost-effective care. The role emphasizes concurrent review, proactive discharge and transition planning, and high dollar claims review primarily for members in hospitals and skilled nursing facilities.

Key Responsibilities

• Perform concurrent and retrospective reviews on facility and home health services.
• Manage care for acutely and chronically ill patients to improve outcomes and reduce costs.
• Provide prior authorizations and discharge planning feedback to providers.
• Determine hospital admission status (observational vs acute inpatient).
• Prepare CMS-compliant notification letters for non-certified days.
• Maintain accurate communication records and monitor utilization reports.
• Coordinate interdisciplinary care and support continuity.
• Identify cost-saving opportunities and clarify health plan benefits.

Requirements

• Minimum 2 years clinical experience as RN, LPN/LVN.
• Experience in health plan utilization management and discharge planning.
• Active unrestricted nursing license.
• Excellent computer and organizational skills.

Benefits & Compensation

• Not specified.

Work Schedule

• Normal business day hours.
• One weekend day per month coverage.
• No explicit call or night shift details.

This role offers a chance to work remotely with a focus on improving senior healthcare outcomes through utilization management. Curana Health is a fast-growing company dedicated to value-based care for older adults.