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Remote Utilization Management Nurse — PACE Care & Compliance

Santa Barbara Cottage Hospital

New York, NY
  • Remote job

IntusCare is seeking a Utilization Management Nurse to ensure high-quality, cost-effective, and compliant care for PACE participants. You will review service utilization, guide care decisions, and support transitions across care settings, collaborating with Interdisciplinary Teams and Medical Directors. The role blends clinical expertise with analytical thinking to ensure services are medically necessary and aligned with care plans and PACE regulations. This is a fully remote US-based position. #J-18808-Ljbffr Santa Barbara Cottage Hospital

Vacancy posted 3 days ago
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