Remote Utilization Review RN Specialist
R1 RCM
R1 RCM is seeking an experienced Utilization Review Author (RN) for our Physician Advisory Team. The role involves first-level admission and continued stay reviews using InterQual/MCG criteria and requires hospital-based UR or Case Management experience. The position offers a flexible schedule with some weekend work and a target annual bonus. Candidates must hold an active RN license and a Bachelor's degree, with strong analytical and communication skills. #J-18808-Ljbffr
Vacancy posted 7 hours ago
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