Remote RN Reviewer: Utilization & Quality Review

HCSC Group; United States; Remote; USD 70,000 - 126,000; Full time

Job summary

Health Care Service Corporation is hiring a Nurse Liaison I for Utilization Management & Quality Review. This remote nationwide role supports clinical review activities, benefit determinations and medical necessity assessments, ensuring compliant, well-documented coverage decisions.

The position requires an RN with an unrestricted license, 3 years of clinical experience (2 in UM/QR), strong analytical and communication skills, and willingness to travel with a valid Illinois driver’s license.

Qualifications

• RN with unrestricted license required.
• 3 years clinical experience with 2 years in utilization review, QA, or related research.
• Clinical knowledge of UM/QR process and managed care principles.
• Analytical, verbal, and written communication skills.
• Current Illinois driver’s license and travel willingness.

Responsibilities

• Support clinical review activities, benefit determinations and medical necessity reviews.
• Assist with benefit terminations and process improvements while maintaining documentation.
• Ensure coverage decisions are clinically sound and well-supported.
• Collaborate with teams to improve UM/QR workflows.

Skills

RN license

Utilization review

Quality assurance

Analytical skills

Communication skills

Travel ready

Medicare experience

Medicare Advantage

Education

Registered Nurse (RN) with unrestricted license

Job description

Health Care Service Corporation is hiring a Nurse Liaison I for Utilization Management & Quality Review. This remote nationwide role supports clinical review activities, benefit determinations and medical necessity assessments, ensuring compliant, well-documented coverage decisions.

The position requires an RN with an unrestricted license, 3 years of clinical experience (2 in UM/QR), strong analytical and communication skills, and willingness to travel with a valid Illinois driver’s license.