About This Role
This remote nursing role is for a Registered Nurse who wants to transition into or grow their career in Utilization Review. It is an opportunity for nurses with acute care experience who enjoy clinical decision-making, medical necessity reviews, and collaborating with providers to support quality patient care and appropriate resource utilization.
Responsibilities
- Conduct medical necessity reviews for inpatient admissions, observation stays, and continued stays
- Apply clinical review criteria to determine appropriate patient status and level of care
- Collaborate with physicians, care managers, and insurance payors to obtain clinical documentation and support appropriate care decisions
- Coordinate peer-to-peer (P2P) reviews and assist with appeals and denial management
- Identify potential overutilization, barriers to patient progress, and opportunities to improve patient outcomes
- Monitor denial trends, readmissions, quality indicators, and revenue cycle workflows
- Maintain accurate documentation while supporting regulatory and payer requirements
Requirements
- Current, unrestricted Registered Nurse (RN) license
- Must have an active compact RN license or be willing to obtain one
- Bachelor's degree in Nursing or a related field, or equivalent experience
- Three years of acute care nursing experience preferred
- Familiarity with medical necessity criteria and quality improvement processes preferred
- Strong clinical assessment, communication, organization, and problem-solving skills
- Ability to work independently in a fast-paced, remote environment
- Reliable high-speed internet access
- Willingness to travel onsite to client, temporary, or corporate locations as business needs require
Benefits
- Fully remote position with a four-day workweek
- Opportunity to apply clinical expertise beyond the bedside
- Additional earning potential through shift and weekend differentials
- Collaborative environment working with physicians, care managers, and healthcare partners
- Opportunity to contribute to quality patient care, appropriate resource utilization, and improved healthcare outcomes
Important Details
- Schedule: Four 10-hour shifts per week with an additional day off; rotating schedule with every other weekend required
- Available shifts: 10:00 AM–8:00 PM; 12:00 PM–10:00 PM
- 10% weekend differential for eligible weekend hours
- 10% evening shift differential for eligible hours worked on the 12:00 PM–10:00 PM shift
- Differentials may combine for up to 20% additional pay on eligible weekend hours worked during the later shift
