Remote RN Review Analyst - Utilization & Care Coordination

Iconma Portal; United States; Remote; USD 65,000 - 95,000; Full time

Benefits offered by this job

Health benefits

Referral program

Excellent growth opportunities

Job summary

Health Insurance Client is seeking a Registered Nurse-Review Analyst for a remote position. The role focuses on medical necessity review across inpatient, outpatient, and ambulatory services, ensuring appropriate level of care and coordination of care plans where needed.

Candidates should have a nursing degree, an active Michigan RN license, and 2–4 years of clinical experience with potential preference for case management certification in a managed care setting.

Qualifications

• Two to four years of clinical experience in health care (acute care, discharge planning, case management, utilization review).
• RN license with current unrestricted Michigan license required.
• Certification in Case Management may be preferred depending on department.

Responsibilities

• Perform prospective, concurrent, and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity and appropriate level of care.
• May establish care plans and coordinate care through the health care continuum including member outreach assessments.

Skills

Clinical experience

Care coordination

Utilization review

Case management

Education

Bachelor’s degree in nursing or related field

RN license (Michigan)

MA Inpatient Precertifi (precertification)

Tools

Certification in Case Management

Job description

Health Insurance Client is seeking a Registered Nurse-Review Analyst for a remote position. The role focuses on medical necessity review across inpatient, outpatient, and ambulatory services, ensuring appropriate level of care and coordination of care plans where needed.

Candidates should have a nursing degree, an active Michigan RN license, and 2–4 years of clinical experience with potential preference for case management certification in a managed care setting.