Utilization Review Nurse - 216041

📢 Now Hiring: Remote Utilization Review RN

Remote | 4x10 Schedule | Weekend & Shift Differentials

Are you an RN looking to transition into or grow your career in Utilization Review? We're seeking a clinically strong, detail-oriented Registered Nurse to join our Utilization Review team!

This is a great 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.

🩺 What You'll Do

• 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.

⏰ Schedule & Pay Differentials

• 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.

The team provides coverage seven days a week between 8:00 AM and 10:00 PM, so flexibility with shift assignments is essential.

✅ Qualifications

• 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.

🌟 Why Consider This Opportunity?

• Fully remote position with a four-day workweek.
• Opportunity to apply your 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.

Interested in learning more? Apply today or send me a message to discuss this opportunity!

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