Utilization Review – RN

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Job ID: 879996

Estimated Weekly Gross: $1,748.42

Job Title

Utilization Management Registered Nurse

Location

Austin, TX (Fully Remote)

Schedule / Job Type

Contract | Days | Full-Time | Remote

Key Responsibilities

• Review admissions and service requests for prospective, concurrent, and retrospective medical necessity and/or compliance with reimbursement policy criteria; provide case management and consultation for complex cases.
• Assist departmental staff with issues related to coding, medical records and documentation, precertification, reimbursement, and claim denials and appeals.
• Assess and coordinate discharge planning needs in collaboration with healthcare team members.
• Prepare statistical analyses and utilization review reports as needed.
• Oversee and coordinate compliance with federally mandated and third-party payer utilization management rules and regulations.

Required Qualifications

• Active Registered Nurse (RN) license in good standing.
• Experience in utilization management, utilization review, or a related clinical discipline.
• Strong critical thinking skills and ability to exercise decisive judgment.
• Ability to work independently with minimal supervision in a fast-paced, stressful environment.

Preferred Experience / Skills

• Experience with clinical documentation improvement (CDI) or case management.
• Familiarity with third-party payer requirements, medical necessity criteria, and denial and appeals processes.

Why Join Us

• Fully remote opportunity allowing flexibility while contributing to meaningful patient care outcomes.
• Engage in a dynamic utilization management environment that values clinical expertise and independent decision-making.

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