Remote Utilization Review RN (Hospital-Based Experience Required)
HealthPlus Staffing
·Yesterday
- Workplace
- Remote
- Type
- Full-time
- Department
- Healthcare
- Experience
- 2+ years
- Source
- RecruiterFlow
Description
Quick Job Details:
Setting: Fully Remote – Utilization Review
Schedule: Full-Time, Monday–Friday
Hours: Standard Business Hours
Job Requirements:
- Active RN license with Multi-State/Compact License required
- Minimum 2 years of Utilization Review experience within a hospital or health system (provider-side required)
- Payer/insurance-only Utilization Management experience is not eligible
- Minimum 3 years of acute care/hospital RN experience
- Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement
- Experience applying InterQual and/or MCG criteria preferred
- Excellent communication, analytical, and critical thinking skills
- Ability to work independently in a remote environment
Responsibilities:
- Conduct admission, concurrent/continued stay, and observation reviews
- Apply medical necessity criteria to determine appropriate level of care
- Escalate cases to Physician Advisors when appropriate
- Collaborate with physicians, case managers, and insurance payers
- Support denial prevention, documentation improvement, and revenue cycle initiatives
- Ensure compliance with payer guidelines, CMS, and regulatory requirements
- Analyze clinical and financial data to identify quality improvement opportunities
Compensation: Competitive; based on experience
Benefits: Comprehensive benefits package
About Us
HealthPlus Staffing is a national leader in healthcare staffing. We partner with leading healthcare organizations nationwide to connect highly qualified professionals with exceptional career opportunities.
Our Promise
- Direct access to hiring decision-makers
- Timely feedback throughout the interview process
- Dedicated support to help you make an informed career decision
If you're interested in this opportunity, please submit your application or call 561-291-7787 to speak with one of our experienced recruiters. We look forward to helping you find your next opportunity!
The HealthPlus Team
Skills
Compliance
