Remote RN: Medical Management & Utilization Specialist

SCAN Health Insurance · Workfromhome, United States

SCAN Health Insurance in the United States is seeking a Medical Management Specialist-RN to promote quality and cost-effective care under regulatory guidelines. Working under the Clinical Supervisor, the RN supports utilization management and case management for complex medical needs.

Responsibilities include ensuring appropriate care, applying evidence-based criteria, escalating to Medical Director, coordinating with the care team, and aiding transitions back into SCAN's network.