Utilization Review RN (Remote)

Job Description

Job Description

Quick Job Details:

Setting: Fully Remote – Utilization Review
Schedule: Full-Time, Monday–Friday
Hours: Standard business hours
Patient Volume: N/A
Job Requirements:

• Active RN license with Multi-State/Compact license required
• Minimum 2 years of Utilization Review experience
• Minimum 3 years of clinical nursing experience (acute care/hospital preferred)
• Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement
• Excellent communication, analytical, and critical thinking skills
• Ability to work independently in a remote environment

Responsibilities:

• Conduct admission, continued stay, and observation reviews
• Apply medical necessity criteria to determine appropriate level of care
• Review cases for Physician Advisor escalation when appropriate
• Collaborate with physicians, case managers, and insurance payers
• Support denial prevention, documentation improvement, and revenue cycle initiatives
• Ensure compliance with payer guidelines and regulatory requirements
• Analyze clinical and financial data to identify quality improvement opportunities

Compensation: Competitive; based on experience

Benefits: Comprehensive benefits package

About Us:

HealthPlus Staffing is a national leader in the healthcare staffing industry. We partner with top healthcare organizations nationwide to connect highly qualified professionals with outstanding career opportunities.

Our Promise:

• We will put you in front of the decision makers.
• We will provide feedback on your application.
• We will work on your behalf to obtain as much information as possible to help you make a well-informed decision.

If you're interested in this opportunity, please submit an application or call View phone number on ziprecruiter.com to speak with one of our experienced consultants. We look forward to helping you find your next opportunity!

The HealthPlus Team