Remote Case Manager: Utilization Review Specialist

Jobgether; Nashville (TN); Remote; USD 85,000 - 110,000; Full time

Job summary

Jobgether is seeking a Case Manager – Utilization Review Specialist for a fully remote role based in the United States. You will oversee admission and concurrent utilization reviews, assess medical necessity, and coordinate appeals to support patient care and financial performance.

You will apply your clinical nursing expertise to evaluate records, collaborate with physicians and payer representatives, and drive continuous improvement in review processes and outcomes.

Qualifications

• Five or more years of acute care nursing experience.
• Five to seven years in case management, discharge planning, utilization review, or a related healthcare discipline.
• Knowledge of healthcare utilization management practices, payer requirements, and regulatory standards.
• Ability to prepare professional appeal letters with clinical evidence and documentation.
• Strong written and verbal communication skills.

Responsibilities

• Oversee admission and concurrent utilization reviews to assess medical necessity.
• Identify potential reimbursement denials and develop strategies to prevent recurrence.
• Coordinate first-, second-, and third-level appeals with complete documentation.
• Maintain accurate documentation of denials, reviews, appeals, and outcomes in databases and systems.

Skills

Clinical nursing experience

Case management

Utilization review

Documentation

Written communication

Verbal communication

HIPAA compliance

Education

RN background

Job description

Jobgether is seeking a Case Manager – Utilization Review Specialist for a fully remote role based in the United States. You will oversee admission and concurrent utilization reviews, assess medical necessity, and coordinate appeals to support patient care and financial performance.

You will apply your clinical nursing expertise to evaluate records, collaborate with physicians and payer representatives, and drive continuous improvement in review processes and outcomes.