Remote Inpatient Utilization Review RN

WellSense Health Plan; United States; Remote; USD 74,000 - 108,000; Full time

Benefits offered by this job

Remote work

Competitive salary

Excellent benefits

Job summary

WellSense Health Plan in the United States is seeking an Inpatient Utilization Management Clinician to evaluate inpatient medical necessity, monitor treatment, and support discharge planning across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and experience with InterQual guidelines and managed care.

You will collaborate with physicians and care management to ensure timely reviews, document outcomes, and maintain regulatory compliance.

Qualifications

• Active RN license in state of residence.
• Bachelor's degree in Nursing or diploma with licensure.
• Experience with InterQual guidelines and managed care is preferred.
• Ability to work remotely and manage after-hours responsibilities.

Responsibilities

• Performs utilization review activities using InterQual criteria and policy.
• Obtains clinical information from EMR to assess timely decisions.
• Determines medical necessity for inpatient services.
• Documents outcomes and communicates with providers and members.
• Refers cases to Physician Reviewer when needed in a timely manner.
• Supports discharge planning and progression of care with care teams.
• Maintains compliance with policies, regulatory requirements, and audits.

Skills

Oral and written communication

Clinical judgement

Interpersonal skills

Independent remote work

MS Office proficiency

Time management

Analytical problem-solving

Education

Bachelor's degree in Nursing

Tools

EMR systems

Job description

WellSense Health Plan in the United States is seeking an Inpatient Utilization Management Clinician to evaluate inpatient medical necessity, monitor treatment, and support discharge planning across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and experience with InterQual guidelines and managed care.

You will collaborate with physicians and care management to ensure timely reviews, document outcomes, and maintain regulatory compliance.