Remote Utilization Review Rn Jobs in Henderson, NV

Job ID: JP00046698

Anticipated Start Date: 08/17/2026

Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs care management activities within the scope of licensure for members with complex and chronic care needs.

Primary duties may include, but are not limited to:

• Ensures medically appropriate, high-quality, cost-effective care through assessing the medical necessity of inpatient admissions and extensions of stay, outpatient services, out of network services, and appropriateness of treatment setting and level of care.

• Partners with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.

• Collaborates with providers to assess consumer needs for early identification of and proactive planning for discharge.

• Conducts clinical assessment to develop goals that address individual needs in order to develop and implement a care plan.

• Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

Requirements:

• Requires a HS diploma or equivalent and a minimum of 3 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.

• Current, active valid unrestricted RN license in applicable state(s) required.

• Multi-state licensure is required if this individual is providing services in multiple states.

• Home health/discharge planning experience preferred.

• AS or BS in nursing preferred.

• Certification as a Case Manager is preferred.

• Current and active RN license required in applicable state(s) that allows for an independent assessment to be conducted within their scope of practice.

• Requires 3 years full-time equivalent of direct clinical care experience to the consumer, 5 years full-time equivalent of direct clinical care experience to the consumer preferred or any combination of education and experience, which would provide an equivalent background, Multi-state licensure is required if this individual is providing services in multiple states.

• Certification as a Case Manager or a BS in a health or human services related field also preferred.

• Standing up a pilot that is coming out of the Whole Health Strategy team. Team is comprised of Health plans and Carelon folks.

• Adaptability & Comfort with Ambiguity

• Problem-solving & Critical Thinking

• Member-Centered Mindset

• Perseverance / Resilience

• Initiative & End-to-End Ownership

Job Type: Possible contract to hire

Additional Details:

• 100% remote

• Nevada licensure- preferred.

• Scope of pilot is Nevada licensure, Connecticut and Missouri.

• Nevada is not a compact state, so they will need 2 sitting in Nevada with a Nevada state license

• Go live is 9/1

• Candidates can sit in any state (within 50 miles of a PulsePoint location), but they must have a compact state licensure

• Work Schedule: Mon -Friday 8am -5pm residing state time zone. They will work in the time zone they live

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

About BCForward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.