Physical Health Registered Nurse – Remote

Partners Health Management

Registered Nurse conducting utilization-management reviews for Vaya Health members. Processing service authorizations, coordinating provider determinations, and supporting safe discharge planning.

Posted 8/5/2026full-timeRemote • Florida, Maryland, North Carolina, South Carolina, Tennessee, Virginia • 🇺🇸 United StatesMid-LevelSenior💰 $68,033 - $88,443 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical reviews, utilization management, and healthcare systems, with a strong focus on communication and problem-solving skills. Proficient in managing authorization requests and adhering to regulatory requirements within a managed care environment.

Highest-signal resume keywords

Utilization Management FunctionsClinical Review Criteria ApplicationActive RN License in North CarolinaFive Years of Clinical ExperienceKnowledge of Healthcare System in North Carolina

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ReviewUtilization ManagementAuthorization ProcessingDischarge PlanningProject Management Principles

Soft Skills

Clear Communication SkillsProblem-Solving SkillsDecision-Making SkillsConflict-Resolution SkillsAbility to Mentor and Coach

Tools & Technologies

Managed Care Information System (MCIS)Microsoft OfficeVaya's Administrative Health RecordCare Management PlatformMember Services and UM Platform

Certifications & Qualifications

Associate Degree in NursingActive RN LicenseNurse Licensure Compact (NLC) License

Industry Keywords

Healthcare SystemManaged CareBehavioral HealthPrimary CareFederal and State Confidentiality Requirements

About the role

Key responsibilities & impact

Complete clinical reviews for appropriateness, medical necessity, and quality
Apply standardized clinical review criteria to service authorization requests
Refer requests to physician peer reviewers when medical necessity criteria are not clearly met
Review pre-service, concurrent, and retrospective requests
Process authorization requests for inpatient, rehabilitation, skilled nursing, home care/home infusion, outpatient, and inpatient services
Document timely decisions and actions in the managed care information system (MCIS)
Meet contractual timelines for review activities
Communicate with providers and internal and external partners to coordinate utilization management activities
Communicate determinations to providers according to established processes
Participate in staff meetings and complex case rounds
Perform discharge planning for safe and timely enrollee discharges
Complete utilization management workflow processes and other assigned UM duties
Participate in weekend and holiday coverage rotations

Requirements

What you’ll need

Associate Degree in Nursing required
Bachelor's Degree in Nursing preferred
Five years of clinical experience, preferably across the continuum of care
At least two years of acute care experience
Experience performing utilization management functions in a managed care setting
Active and unrestricted RN license in North Carolina or Nurse Licensure Compact (NLC) license
Thorough knowledge of primary care, behavioral health, and the healthcare system in North Carolina
Knowledge of Vaya Health's provider network, medical-practice workflows, contracts, policies, procedures, and organizational role
Knowledge of federal and state confidentiality requirements and member/staff health and safety requirements
Knowledge of project-management principles
Clear, concise verbal, written, and electronic communication skills
Ability to present in large-group settings and adapt to rapid changes
Ability to implement new initiatives
Computer literacy and proficiency with Microsoft Office, Vaya's Administrative Health Record, and/or Care Management Platform and Member Services and UM Platform
Problem-solving, decision-making, conflict-resolution, and critical-thinking skills
Ability to mentor, coach, facilitate change and innovation, and develop reporting mechanisms for quality initiatives
Ability to perform sedentary work, sit for extended periods, and lift up to 10 pounds
Close visual acuity, extensive reading, and repetitive hand, wrist, and finger motion required
Must live in North Carolina, South Carolina, Georgia, Tennessee, Virginia, Maryland, or Florida

Benefits

Comp & perks

Home-based, virtual work position
Monday–Friday schedule, 8:30am–5:00pm EST
Equal opportunity employer