Utilization review nurse [h1.location_city]

V lenz® Health is the platform to simplify healthcare - the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey - from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.

About This Opportunity :

As a Utilization Management Nurse, you will have a meaningful impact each day by delivering comprehensive, patient centered care. You'll assess individual needs, shape personalized care plans, and bring together the right healthcare partners to keep patients moving forward. With your clinical insight, you'll help members navigate the healthcare system with confidence, reinforce treatment plans, and champion high quality outcomes through clear communication, education, and steady support. You'll also play an important role in promoting wellness, using resources wisely, and ensuring we meet both regulatory and organizational standards.

You'll also have the chance to work on a wide variety of cases, which is a great way to build new skills, expand your clinical thinking, and grow your expertise over time.

Things You'll Do Here :

• Review prospective, concurrent, and retrospective UM cases and apply the appropriate criteria and plan documents.
• Work with providers and internal partners to make sure the right guidelines are used within the required timelines.
• Support quality care and cost-effective outcomes that help members stay healthy and engaged.
• Follow CMS, URAC, and other regulatory requirements tied to UM activities.
• Flag any potential overuse, underuse, or misuse of services.
• Identify high risk, catastrophic, or disease management cases and route them to the right teams.
• Communicate UM decisions clearly with providers and members so everyone stays aligned.
• Document UM activities accurately and maintain confidentiality at all times.
• Participate in ongoing education to keep your UM knowledge fresh and current.
• Help support smooth transitions of care for inpatient members, including early discharge planning.
• Bring forward any potential quality or patient safety concerns.
• Take on additional responsibilities as needed to support the team.

Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.

What You'll Bring to the Team :

A plus if you have :

Where You'll Work : This is a fully remote position, and we'll provide all the necessary equipment!

Schedule : This role follows a full time, Monday through Friday schedule during standard business hours. Below you'll find the schedule according to your time zone.

Why You'll Love Working Here

Valenz is proud to be recognized by Inc. 5000 as one of America's fastest-growing private companies. Our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare . With this commitment, you'll find an engaged culture - one that stands strong, vigorous, and healthy in all we do.

Benefits

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and / or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.