Utilization Management RN – Remote
Utilization Management RN – Remote
Location: Fully Remote (Must reside in PA, NJ, or DE for permanent conversion)
Position Type: Contract (6–12+ months) with potential for full-time conversion
As a Utilization Management Nurse, you will:
• Review medical records to determine medical necessity for services
• Apply clinical guidelines such as InterQual, Milliman, or MCG
• Approve care based on established criteria
• Refer cases not meeting criteria to the Medical Director
• Communicate with providers to obtain or clarify clinical information
• Work fully remote in an analytical, non-bedside role
Qualifications
• Active RN license (required)
• Associate’s or Bachelor’s degree in Nursing (BSN preferred)
• 3+ years hospital or clinical experience
• Utilization Management, Prior Authorization, or Medical Management experience (hospital or insurance)
• InterQual or similar criteria experience (Milliman, MCG)
• Strong critical thinking and communication skills
What We Offer
• Fully remote work with equipment provided
• Contract-to-hire opportunity with strong conversion potential
• Competitive hourly rate
• Opportunity to work with a well-established health insurance organization
Apply Now
Apply Now
Location: Fully Remote (Must reside in PA, NJ, or DE for permanent conversion)
Position Type: Contract (6–12+ months) with potential for full-time conversion
As a Utilization Management Nurse, you will:
• Review medical records to determine medical necessity for services
• Apply clinical guidelines such as InterQual, Milliman, or MCG
• Approve care based on established criteria
• Refer cases not meeting criteria to the Medical Director
• Communicate with providers to obtain or clarify clinical information
• Work fully remote in an analytical, non-bedside role
Qualifications
• Active RN license (required)
• Associate’s or Bachelor’s degree in Nursing (BSN preferred)
• 3+ years hospital or clinical experience
• Utilization Management, Prior Authorization, or Medical Management experience (hospital or insurance)
• InterQual or similar criteria experience (Milliman, MCG)
• Strong critical thinking and communication skills
What We Offer
• Fully remote work with equipment provided
• Contract-to-hire opportunity with strong conversion potential
• Competitive hourly rate
• Opportunity to work with a well-established health insurance organization
Apply Now
Apply Now