Utilization Management QA RN

HealthEdge

UM QA RN responsible for facilitating program creation, audit reviews, and team education in healthcare settings. Requires 2+ years experience and strong analytical skills for quality assurance.

Posted 5/21/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $65,000 - $85,000 per yearWebsite

About the role

Key responsibilities & impact

Assisting and in organizing and facilitating strategic program creation
Providing in-depth analysis on current processes and implementation
Assisting in researching and compiling appropriate and relevant data and feedback for risk activities
Performing QA audits on completed prospective and concurrent reviews of inpatient, outpatient, ambulatory and ancillary services
Developing and delivering targeted education for the team related to policies, procedures, benefits when appropriate
Maintaining comprehensive knowledge of business, products, corporate organizational structure
Performing quality audits on calls
Assisting in monitoring initiatives, outcomes, and objectives to ensure goal attainment
Developing lines of communication to discuss/review results of analysis to management via reports/presentations
Assisting leadership by investigating, reviewing, and recommending innovative solutions
Assisting in identifying resolution of challenges and issues to fulfill key corporate objectives

Requirements

What you’ll need

2+ years’ experience in US Healthcare in utilization management and/or Quality Assurance review
HealthEdge HRCM, JIRA or Guiding Care experience is a plus
Strong analytical, planning, problem solving, verbal, and written skills to communicate complex ideas
Strong knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.)
Ability to work independently, within a team environment, and communicate effectively with employees and clients at all levels
Flexibility and ease with changing tasks and priorities
Detail oriented
Performing technical tasks such as creating business requirements documents and user training manuals and guides

Benefits

Comp & perks

Health insurance
401(k) matching
Paid time off
Flexible work arrangements

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

utilization managementQuality Assurance reviewdata analysisquality auditsbusiness requirements documentsuser training manualstargeted education development

Soft Skills

analytical skillsplanningproblem solvingverbal communicationwritten communicationdetail orientedflexibilityteamworkindependence