About the job
🚨 We’re Hiring: Utilization Management Nurse (Remote) 🚨
Position: Utilization Management Nurse (RN)
Type: Contract-to-Hire (eligible after 800 hours)
If you’re an experienced RN with utilization review experience and a passion for evidence-based care, this is a great opportunity to join a mission-driven organization — 100% remote.
🕒 Schedule
- Tues–Sat or Wed-Sat
- 8:30 AM – 5:00 PM or 4x10s
- Training: Monday–Friday, 8:30 AM–5:00 PM (6–8 weeks)
🔍 Role Overview
In this role, you’ll conduct frequent case reviews, analyze medical records, collaborate with providers, and make recommendations on the appropriateness of care using evidence-based guidelines.
🩺 Key Responsibilities
- Review medical records and collect clinical information (phone/fax)
- Apply evidence-based guidelines (Clinical Guidelines, MCG, InterQual, Hayes, UpToDate, etc.)
- Determine medical necessity and meet required decision timelines
- Escalate cases for physician review when appropriate
- Document decisions clearly within utilization review platforms
- Refer members for additional care engagement when needed
- Participate in quality improvement initiatives
- Maintain active licensure and continuing education
✅ Required Qualifications
- Active, unrestricted RN license (single-state or compact/NLC)
- ADN or BSN (or graduate of an accredited nursing program)
- 1+ year utilization review experience in managed care
- 1+ year acute clinical experience (ER or hospital setting)
- Experience with MCG or InterQual
- Ability to obtain additional state licenses as needed
⭐ Preferred Qualifications
- BSN
- Strong multitasking and organizational skills
- Familiarity with Google platforms and comfort learning new tools
📩 Interested or know someone who’d be a great fit?