Clinical Review Nurse - Concurrent Review

Utilization Review Registered Nurse

This role focuses on performing comprehensive concurrent and utilization reviews to ensure members receive medically necessary, high-quality, and cost-effective care at the appropriate level and setting. The Utilization Review Registered Nurse evaluates clinical information, applies medical necessity criteria, collaborates with healthcare providers and internal medical teams, and supports discharge planning and care coordination across the continuum of care.

Responsibilities

• Conduct concurrent utilization reviews to assess medical necessity, appropriate level of care, and ensure services meet clinical guidelines and member benefits.
• Partner with providers, care teams, and Medical Directors to support care decisions, authorizations, discharge planning, and smooth transitions of care.
• Document review findings, monitor quality and resource utilization, and help improve care outcomes through ongoing collaboration and provider education.

Essential Skills

• Active Compact Registered Nurse (RN) license
• ADN or BSN, obtained from graduation at an accredited school of nursing or a bachelor's degree in nursing.
• 24 years of acute care nursing hospital experience.
• 24 years of related clinical or utilization review experience.

Additional Skills & Qualifications

• Experience using medical necessity tools such as InterQual or MCG.
• Experience in UM (Utilization Management) review and post-acute oversight.

Work Environment

This position is 100% remote, with a preference for candidates located in Central, Mountain, or Pacific time zones, though schedules must support all U.S. time zones. The role operates on 8-hour shifts, Monday through Friday, with occasional rotating weekend and holiday coverage as needed. Start times may be as early as 8:00 AM Eastern Time, and end times may extend to 5:00 PM Pacific Time, with specific 8-hour shifts assigned within that window. The work environment emphasizes collaboration, clear communication, and alignment around shared goals. The team culture supports a utilization management center of excellence, enhances post-acute oversight, and promotes consistent, coordinated care across the continuum. Expectations are clearly defined while allowing flexibility to support one another and adapt to evolving priorities in a fully remote setting.

Job Type & Location

This is a Contract to Hire position based out of San Antonio, TX.

Pay and Benefits

The pay range for this position is $36.00 - $40.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully remote position.

Application Deadline

This position is anticipated to close on Sep 25, 2026.