Utilization Management RN

$39 - $40 per hour

The Judge Group Inc

1 week ago Be among the first 25 applicants

This range is provided by The Judge Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$39.00/hr - $40.00/hr

Direct message the job poster from The Judge Group

Lead Healthcare Recruiter at The Judge Group

Utilization Management Registered Nurse (RN)

Type: 6-Month Contract W2

Location: Remote - but MUST reside in one of the following states: IL, TX, NM, OK, MT, TN
Schedule: Monday–Friday, 8:00 AM–5:00 PM EST or CST. No nights or weekends required!

Compensation: $40/hour

Summary: We are seeking a Utilization Management RN to join our team on a remote, contract basis. This role is ideal for a nurse with recent experience in health plan operations and utilization review. You will be responsible for evaluating healthcare services, coordinating care, and ensuring members receive high-quality, cost-effective treatment.

Responsibilities

Perform delegated tasks within the Nurse Case Management job family
Collaborate with physicians to plan, implement, and evaluate healthcare services
Use clinical expertise to assess, coordinate, and monitor care options for optimal outcomes
Conduct utilization reviews (prospective, concurrent, retrospective) for inpatient, outpatient, and rehabilitation services
Provide health education and clinical assessments to members
Independently manage caseloads and coordinate assigned cases
Resolve escalated issues and support junior team members
Evaluate alternative care services to ensure program goals and cost-effective care
Maintain compliance with clinical guidelines and regulatory standards

Qualifications

Active, unrestricted RN license in the U.S.
Minimum 2 years of Utilization Management RN experience, including Prior Authorization and Concurrent Review
Experience working for a health plan (payer) within the last 3 years
Proficiency with Milliman Care Guidelines (MCG) or InterQual Criteria
Strong computer literacy and comfort with digital tools

Ready to make a meaningful impact—without sacrificing work-life balance? If you're a passionate RN with a sharp eye for clinical detail and a heart for patient advocacy, we’d love to hear from you. This is your chance to bring your expertise to a dynamic team, work remotely, and help shape better healthcare outcomes across the country.

Apply now and let’s do great work together!
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