Remote Position
Utilization Management RN – Remote
🌍 Remote · United States
💼 Full-time
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 tot his job