Utilization Review Nurse - 249106

We're Hiring: Utilization Review Nurse (RN) – 100% Remote

Looking for your next opportunity in Utilization Review? If you're an experienced RN with a strong background in utilization review and a passion for evidence-based care, this is your chance to join a mission-driven organization from the comfort of home.

The full job description covers all associated skills, previous experience, and any qualifications that applicants are expected to have.

Position Details

• Role: Utilization Review Nurse (RN)

• Type: Contract-to-Hire (eligible after 800 hours)

• Location: 100% Remote

Schedule Options

• Sunday–Thursday or Tuesday - Saturday

• 8:30 AM – 5:00 PM or 4x10s

• Training: Monday–Friday, 8:30 AM – 5:00 PM (4-5 weeks)

What You'll Do

• Reviews current inpatient or ongoing treatment plans
• Checks medical records, labs, and physician notes
• Communicates with doctors, case managers, and care teams
• Applies clinical guidelines like MCG
• Determines if the level of care (inpatient vs observation) is appropriate
• Recommends continued stay, discharge, or alternative care settings

Required Qualifications

• Active, unrestricted RN license (single state or compact/NLC)

• Associate or Bachelor's Degree in Nursing (or accredited program graduate)

• Experience with MCG guidelines

• Ability to obtain additional state licenses if needed

• 1+ year of utilization review experience doing concurrent xhyhwjd reviews (managed care)

• 1+ year of clinical experience in an acute care setting (ER, hospital, etc.)

Preferred Qualifications

• BSN

• Experience with concurrent or inpatient reviews for a health plan

Interested or know someone who is?

Apply today or message me directly to learn more!

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