Remote Nurse Reviewer — Utilization & QR

Health Care Service Corp.; United States; Remote; USD 70,000 - 126,000; Full time

Job summary

Health Care Service Corporation in the United States seeks a Registered Nurse for Utilization Management and Quality Review oversight. The role requires 5+ years of nursing experience with UR/QR exposure and travel as needed. This is a remote, nationwide position with potential for professional development.

The successful candidate will support clinical review activities, ensure compliance, and contribute to decisions affecting benefits and patient care across the health plan.

Qualifications

• Registered Nurse (RN) with an unrestricted license.
• 3 years clinical experience with 2 years in utilization review, quality assurance, or statistical research.
• Clinical knowledge, UM/QR process, and managed care principles.
• Analytical, verbal, and written communications skills.
• Current Illinois driver’s license.
• Able and willing to travel, including overnight stays.

Responsibilities

• Assist with benefit determinations and medical necessity reviews, ensuring sound, well-documented coverage decisions and compliance.

Skills

RN license

Clinical experience

UM/QR knowledge

Analytical skills

Driver's license

Travel willingness

Job description

Health Care Service Corporation in the United States seeks a Registered Nurse for Utilization Management and Quality Review oversight. The role requires 5+ years of nursing experience with UR/QR exposure and travel as needed. This is a remote, nationwide position with potential for professional development.

The successful candidate will support clinical review activities, ensure compliance, and contribute to decisions affecting benefits and patient care across the health plan.