Registered Nurse - Utilization Management (Remote)

Mitchell Martin Inc.; Philadelphia (Philadelphia County); Remote; USD 56,000 - 63,000; Full time

Job summary

Mitchell Martin Inc. is seeking a Registered Nurse specialized in Utilization Management for a remote role based in PA/NJ/DE. This contract position runs Monday through Friday during the day, with a competitive hourly pay range.

The ideal candidate brings strong clinical judgment, UM experience, and the ability to navigate appeals and regulatory requirements while maintaining clear written and verbal communication with stakeholders.

Qualifications

• Active RN license in PA or Compact states.
• Minimum five years of clinical nursing or equivalent healthcare experience.
• Experience in utilization management or related managed care operations.
• Knowledge of clinical appeal processing and regulatory requirements.
• Strong written and verbal communication skills.

Responsibilities

• Provide utilization management review and clinical decision making.
• Communicate effectively in writing and verbally with providers and payers.
• Manage multiple priorities and meet deadlines in a fast-paced environment.
• Utilize generic technology tools and systems to support UM processes.

Skills

RN license PA/Compact

Utilization management experience

Regulatory knowledge (appeals)

Clinical judgment

Written and verbal communication

Prioritization & deadline management

Education

BSN Preferred

Tools

Electronic Health Records (EHR)

Job description

Registered Nurse - Utilization Management (Remote) - Philadelphia, PA (Remote) - Contract - Mon-Fri, Day Shift Hours - $41.15-$46.15 Per HR

Title

Registered Nurse - Utilization Management (Remote)

Location

Philadelphia, PA (Remote)

Employment Type

Contract - Mon-Fri, Day Shift Hours

Compensation

Pay Range: $41.15-$46.15 Per HR

Description

• This position involves working as a Registered Nurse specializing in Utilization Management.
• The role is remote, with a requirement to reside in PA, NJ, or DE.
• It is a contract position with day shift hours from Monday to Friday.
• The role requires strong clinical judgment and experience in utilization management, along with proficiency in generic technology tools.

Requirements

• Active, unrestricted RN license in PA or Compact states.
• Minimum of five years of clinical nursing or equivalent healthcare experience.
• Experience in utilization management or related managed care operations.
• Knowledge of clinical appeal processing and regulatory requirements.
• Strong written and verbal communication skills.
• Ability to manage competing priorities and meet deadlines.
• Proficiency with generic technology tools and systems.

Qualifications

• BSN Preferred.
• Experience in health plan operations, including various plan types.
• Familiarity with utilization review criteria and guidelines.
• Experience with external review and complex medical necessity appeals.
• Knowledge of Medicare, Medicaid, and state-specific appeal requirements.
• Experience working with cross-functional healthcare teams.

Benefits

Learn more about our benefits offerings here https://www.mitchellmartin.com/careers/benefits-perks

Onboarding Expectations

Learn more about our Onboarding Process here https://youtu.be/rjV_NFYjyY4

EEO Statement

Learn more about our EEO policy here https://www.mitchellmartin.com/eoe-statement

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