Inpatient Utilization Review Nurse (RN)

NurseRemotely; United States; Remote; USD 94,000 - 142,000; Full time

Job summary

Point32Health is seeking an experienced Clinical Reviewer, Inpatient RN to manage clinically complex inpatient cases across multiple lines of business. You will determine medical necessity, apply evidence-based criteria, and lead discharge planning while collaborating with providers and care teams.

The role requires an active Massachusetts RN license (or eligibility), 3+ years in nursing and UM, and the ability to work remotely within the US, with strong communication and mentoring skills to

Qualifications

• RN license with active MA license (or eligible)
• Minimum 3 years of clinical nursing experience; 3 years in Utilization Management
• BSN preferred; continuing education aligned with UM evidence-based criteria

Responsibilities

• Provide UM activities for inpatient members across defined LOS and care settings.
• Apply industry standard and plan criteria to determine medical necessity and level of care.
• Lead discharge planning and document case activities per department standards.
• Review admissions and continued stays; coordinate transitions in care and network referrals.
• Mentor teammates and participate in weekly UM/CM rounds and cross‑functional initiatives.

Skills

Utilization Management

Clinical Nursing

Effective communication

Time management

Mentoring

Clinical judgement

Problem solving

Education

Associate degree

BSN preferred

Tools

Microsoft Word

Microsoft Excel

EMR systems

Job description

Point32Health is seeking an experienced Clinical Reviewer, Inpatient RN to manage clinically complex inpatient cases across multiple lines of business. You will determine medical necessity, apply evidence-based criteria, and lead discharge planning while collaborating with providers and care teams.

The role requires an active Massachusetts RN license (or eligibility), 3+ years in nursing and UM, and the ability to work remotely within the US, with strong communication and mentoring skills to