Job Description
Job Description
Registered Nurse – Utilization Review (Acute Care Experience Required)
Location: Fully remote (PA RN License Required)
Schedule: Monday – Friday, 8:45 AM – 5:00 PM; required to work every 4th Saturday
Position Overview:
We are seeking a skilled and detail-oriented Registered Nurse (RN) with a valid PA license to join our team in a Utilization Review capacity. This position is ideal for an RN with direct acute hospital experience or prior work in insurance utilization review. This is not a Case Management or Home Care nursing role—applicants must have hands-on acute hospital experience to be considered.
Key Responsibilities:
Conduct clinical reviews to determine medical necessity and appropriateness of care
Apply evidence-based criteria to assess patient treatment plans and services
Collaborate with healthcare providers and insurance partners to ensure efficient, quality patient care
Document review findings accurately and in a timely manner
Maintain compliance with internal and external regulatory standards
Required Qualifications:
~ Active and unrestricted PA RN license
~3–5 years of recent direct care experience in an acute hospital setting (ICU, ED, Med/Surg, etc.)
~ OR prior experience in insurance utilization review or hospital-based utilization management
~ Strong clinical judgment and knowledge of hospital workflows
~ Proficient in using clinical review tools and electronic health records
Preferred Experience:
Prior work in payer-side utilization review is highly desirable
Familiarity with InterQual or Milliman criteria
Work Schedule:
Monday through Friday, 8:45 AM – 5:00 PM
Required to work every 4th Saturday of the month
Job Tags
Saturday, Monday to Friday,
Similar Jobs
Steven Lacey Concept Solutions
...opportunities. This flexible position offers the convenience of working from home with competitive pay and flexible scheduling options. Key... ...Peak hours: 9 AM - 5 PM (preferred but flexible) Weekend availability: Optional for additional hours Getting Started...
First American Bank
...visibility, career growth, and stability that is difficult to find in many larger corporations.The Defined Contribution Retirement Plan Senior Administrator specializes in the design and administration of more complex defined contribution retirement plans for small to...
American Traveler
...American Traveler is seeking a travel nurse RN ED - Emergency Department for a travel nursing job in Lincoln, Maine. Job Description & Requirements ~ Specialty: ED - Emergency Department ~ Discipline: RN ~ Start Date: 07/31/2025~ Duration: 8 weeks ~36 hours...
Manpower
...Cashier / Stocker $15.00 Our client in Columbus, IN is looking for hardworking, motivated talent to join their team. What's in it for you?~$14.00 per hour ~ Day Shift, rotating Saturday's for 4 hours ~ Paid training~15-30 hours per week~ Clean and...
AccentCare, Inc.
Overview: Find Your Passion and Purpose as a Full Time Hospice Music Therapist Reimagine Your Career in Hospice as a Board... ...Be Bachelor's Degree in Music with a concentration in Music Therapy and/or Music Therapy from an American Music Therapy Association...