Registered Nurse – Utilization Review (Remote)

About the role

As a Registered Nurse in Utilization Review, you will work remotely to ensure that patient admissions and services meet clinical criteria and payer requirements. You’ll collaborate with interdisciplinary teams to optimize care delivery, manage resources, and support compliance.

Key responsibilities

• Conduct prospective, concurrent, and retrospective medical necessity reviews for admissions and service requests.
• Provide high‑level case management and specialized consultation for complex patient cases.
• Assist teams with coding accuracy, clinical documentation, precertification, and manage claim denials or appeals.
• Coordinate discharge planning with the healthcare team to ensure safe, timely patient transitions.
• Maintain compliance with federal and third‑party payer regulations and generate utilization reports and statistical analyses.

Required profile

• Active Registered Nurse licensure in the state where work is performed.
• Diploma from an accredited nursing program or equivalent professional licensure.
• 2–3 years of direct experience in utilization management or a managed‑care environment.

Required skills

• Utilization Management
• Case Management
• Medical Coding
• Clinical Documentation
• Precertification
• Denial Management

What we offer

• Comprehensive health, dental, vision, and prescription coverage.
• Employer‑matched 403(b) retirement plan and disability/life insurance.
• Paid time off, holidays, and flexible work schedule.
• Tuition assistance, professional development, and online learning resources.
• Employee assistance program, counseling, spiritual care, and family support benefits.