Utilization Management RN (Compact Licensed)

About the role

Clearlink Partners is seeking a Registered Nurse with a compact license to join its managed‑care consultancy team. The Utilization Management RN will evaluate the medical necessity and appropriateness of services for Medicaid, Medicare Advantage, and other complex care populations.

Key responsibilities

• Perform 15‑30 utilization reviews daily, including initial and concurrent inpatient admissions, outpatient surgeries, and ancillary services.
• Apply medical guidelines such as MCG and InterQual to determine service appropriateness and compliance with state regulations.
• Document review determinations, communicate findings to providers and members, and collaborate with Medical Directors on complex cases.
• Identify care gaps, expedite referrals, and support discharge planning for low‑income and vulnerable members.
• Contribute to team discussions, share expertise, and suggest process‑improvement initiatives.

Required profile

• Registered Nurse holding a compact license.
• Experience in utilization management or medical review within managed‑care settings.
• Strong knowledge of clinical review criteria and state‑mandated regulations.
• Ability to interpret member needs, prioritize cases, and advocate for cost‑effective treatment plans.

Required skills

• Proficiency with medical guideline systems (MCG, InterQual).
• Clinical information gathering and documentation.
• Collaboration with multidisciplinary teams.

What we offer

• Opportunity to work with a leading managed‑care consultancy.
• Engagement with diverse patient populations and complex clinical cases.
• Professional development in health‑equity and quality‑outcome initiatives.