Registered Nurse

OpTech; Michigan; Remote; USD 50,000 - 52,000; Full time

Benefits offered by this job

Health benefits

Dental benefits

Flexible/remote work options

Training opportunities

Growth opportunities

401K

Job summary

OpTech is seeking a Registered Nurse (RN) to support utilization review and clinical review activities for a Michigan health plan. This role involves evaluating medical services for medical necessity, level of care, and clinical criteria. The ideal candidate has utilization management experience in health plans or hospitals.

Strong candidates with recent ICU/ER/Medical-Surgical experience are encouraged to apply. The position offers flexible/remote work options and competitive pay.

Qualifications

• Active, unrestricted Michigan RN license.
• Experience in utilization review or utilization management within a health insurance plan or hospital setting.
• 2+ years of recent hands-on clinical nursing experience in ICU/ER/Medical-Surgical.

Responsibilities

• Review medical records and service requests to evaluate medical necessity, level of care, and length of stay.
• Conduct prospective, concurrent, and retrospective clinical reviews.
• Review and document clinical findings, decisions, and appeals.
• Coordinate discharge planning and collaborate with providers and internal teams.
• Apply clinical guidelines and identify appropriate care alternatives when necessary.

Skills

Utilization management

Clinical documentation

Analytical skills

Effective communication

Typing 35 WPM

Tools

Microsoft Office

Job description

Location: Remote (Must reside in Michigan)

Position Type: Full-Time (40 hours/week)

Pay Rate: $36.00 – $38.00 / hour

Position Overview

We are seeking a Registered Nurse (RN) to join a healthcare team supporting utilization review and clinical review activities for a Michigan health plan. This role evaluates medical services to ensure they meet medical necessity guidelines, appropriate levels of care, and established clinical criteria.

The ideal candidate will have experience in utilization management within a health insurance plan or hospital setting.

Nurses with strong, recent acute-care experience in the ICU, Emergency Room, or Medical-Surgical unit are also encouraged to apply if they meet the clinical experience requirements.

This position is an excellent opportunity for a clinically experienced RN interested in applying nursing knowledge to healthcare reviews, care coordination, and clinical decision-making.

Key Responsibilities

• Review medical records and service requests to evaluate medical necessity, level of care, and length of stay.
• Conduct prospective, concurrent, and retrospective clinical reviews.
• Review and document clinical findings, decisions, and appeals.
• Coordinate discharge planning and collaborate with providers and internal teams.
• Apply clinical guidelines and identify appropriate care alternatives when necessary.

Required Qualifications

• Active, unrestricted Michigan RN license.
• Candidates must meet one of the following experience pathways:
• Experience in utilization review or utilization management within a health insurance plan or hospital setting.

Pathway 2: Recent Acute-Care Experience

• 2 + years of recent, hands-on clinical nursing experience in an ICU, Emergency Room (ER), or Medical-Surgical unit.
• Strong clinical assessment, analytical, and documentation skills.
• Excellent written and verbal communication skills.
• Computer proficiency, including Microsoft Office and navigating multiple systems.
• Typing speed of at least 35 WPM.

When you work at OpTech, not only do you get health and dental benefits, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay.

OpTech is an Equal Opportunity Employer (EOE), all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected vetera n.