Remote RN Review Analyst — Inpatient Precertification

Epitec; Detroit (MI); Remote; USD 41,000 - 55,000; Full time

Job summary

Epitec seeks a Registered Nurse Review Analyst to support inpatient precertification and utilization management in a fully remote environment. You will perform prospective, concurrent, and retrospective medical reviews to determine medical necessity, level of care, intensity of service, and length of stay for healthcare services.

The ideal candidate has a strong clinical background, experience evaluating patient care needs, and the ability to collaborate with providers, facilities, and members

Qualifications

• Active, unrestricted Michigan RN license.
• 2-4 years of clinical nursing experience.
• Experience with acute care, discharge planning, case management, or utilization review.
• Ability to work independently in a remote setting.
• Strong analytical and communication skills.
• Knowledge of utilization management guidelines.

Responsibilities

• Perform prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory, and ancillary services.
• Evaluate medical necessity, level of care, intensity of service, and appropriate length of stay.
• Review and assess appeal requests submitted by providers, facilities, and members.
• Apply clinical knowledge and evidence-based guidelines to utilization review decisions.
• Establish care plans and coordinate care across the healthcare continuum when appropriate.
• Conduct member outreach and assessments to support care coordination initiatives.
• Collaborate with physicians, healthcare providers, and interdisciplinary teams to facilitate quality patient care.

Skills

RN license

Clinical nursing

Analytical skills

Communication skills

Independent work

Education

Bachelor's degree in Nursing

CCM certification

Job description

Epitec seeks a Registered Nurse Review Analyst to support inpatient precertification and utilization management in a fully remote environment. You will perform prospective, concurrent, and retrospective medical reviews to determine medical necessity, level of care, intensity of service, and length of stay for healthcare services.

The ideal candidate has a strong clinical background, experience evaluating patient care needs, and the ability to collaborate with providers, facilities, and members