Remote MI RN — Utilization Review & Care Coordination

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

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.