Remote Utilization Review RN (Hospital-Based Experience Required)

Fully Remote Utilization Review Position

Setting: Fully Remote – Utilization Review

Schedule: Full-Time, Monday–Friday

Hours: Standard Business Hours

Job Requirements:

• Active RN license with Multi-State/Compact License required
• Minimum 2 years of Utilization Review experience within a hospital or health system (provider-side required)
• Payer/insurance-only Utilization Management experience is not eligible
• Minimum 3 years of acute care/hospital RN experience
• Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement
• Experience applying InterQual and/or MCG criteria preferred
• Excellent communication, analytical, and critical thinking skills
• Ability to work independently in a remote environment

Responsibilities:

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

Compensation: Competitive; based on experience

Benefits: Comprehensive benefits package

HealthPlus Staffing is a national leader in healthcare staffing. We partner with leading healthcare organizations nationwide to connect highly qualified professionals with exceptional career opportunities.

Our Promise:

• Direct access to hiring decision-makers
• Timely feedback throughout the interview process
• Dedicated support to help you make an informed career decision

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

The HealthPlus Team