Utilization Management Nurse - Post Acute

Title : Utilization Management Nurse - Post Acute
Location : Remote, candidates must have a home address within Minnesota or Wisconsin
Job Type : Contract (6 months) + potential to extend/convert
Compensation : $40-45/hr 
Industry: Health Insurance

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About the Role
Our client is a nationally recognized health insurance organization that serves individuals, families, employers, and government-sponsored healthcare programs. We are seeking an experienced Utilization Management Nurse - Post Acute to support the review and management of post-acute care services. This role is ideal for a registered nurse with a strong clinical background and utilization management experience who is passionate about ensuring members receive medically appropriate, high-quality care.
The Utilization Management Nurse will play a key role in evaluating post-acute care requests, applying evidence-based clinical criteria, and collaborating with healthcare providers and interdisciplinary teams to support optimal member outcomes. Job Description
As a Utilization Management Nurse - Post Acute, you will review and document prior authorization and concurrent stay requests while ensuring compliance with clinical guidelines, regulatory requirements, organizational policies, and member benefit coverage.
Key Responsibilities:

• Conduct utilization reviews for post-acute care services, including:
  • Skilled Nursing Facilities (SNF)
  • Acute Inpatient Rehabilitation Facilities (IRF)
  • Long-Term Acute Care Hospitals (LTACH)
• Evaluate medical necessity using established clinical criteria and evidence-based guidelines, including MCG criteria.
• Review member medical histories and clinical documentation to support authorization decisions.
• Process prior authorization and concurrent stay review requests accurately and timely.
• Collaborate with physicians, medical directors, case managers, providers, facilities, intake teams, and other internal stakeholders.
• Document clinical determinations and utilization review activities in accordance with organizational standards and regulatory requirements.
• Support quality, compliance, and cost-effective care management initiatives while maintaining a member-centered approach.

Qualifications
Education:

• Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) required.

Licensure:

• Active, unrestricted Registered Nurse (RN) license required.

Experience:

• 3+ years of clinical nursing experience.
• Prior Utilization Management experience focused on post-acute care required.
• Experience reviewing skilled nursing, rehabilitation, and long-term acute care services preferred.
• Experience applying medical necessity guidelines such as MCG preferred.

Skills & Qualifications:

• Strong clinical assessment, critical thinking, and decision-making abilities.
• Ability to evaluate complex clinical information and make evidence-based determinations.
• Excellent organizational skills with strong attention to detail.
• Self-directed and able to work independently while collaborating effectively within a team environment.
• Strong written and verbal communication skills.
• Proficient with multiple computer systems, electronic medical records, and utilization management platforms.
• Ability to manage competing priorities in a fast-paced healthcare environment.

Benefits
Dahl Consulting is proud to offer a comprehensive benefits package to eligible employees that will allow you to choose the best coverage to meet your family’s needs. For details, please review the DAHL Benefits Summary:  How to Apply
Take the first step on your new career path!  To submit yourself for consideration for this role, simply click the apply button and complete our mobile-friendly online application. Once we’ve reviewed your application details, a recruiter will reach out to you with next steps! Equal Opportunity Statement
As an equal opportunity employer, Dahl Consulting welcomes candidates of all backgrounds and experiences to apply. If this position sounds like the right opportunity for you, we encourage you to take the next step and connect with us. We look forward to meeting you!