Remote RN: Utilization Management Reviewer

Sagility; United States; Remote; USD 48,000 - 55,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401K with employer contribution

PTO and Sick Time

Job summary

Sagility is hiring an RN Utilization Management Reviewer for a fully remote, home-based role in the United States. You will perform day-to-day clinical and service authorization reviews for medical necessity and ensure compliance with CMS standards.

Qualified candidates hold an MA RN license with an Associate's degree, and 1–2 years of UM experience in a clinical setting. CCM is a plus; strong communication and teamwork skills are essential.

Qualifications

• RN with Associate's Degree or higher and active MA RN license.
• CCM certification is a plus.
• 1–2 years Utilization Management experience in a clinical setting.

Responsibilities

• Perform timely clinical and service authorization reviews for medical necessity.
• Apply InterQual and other criteria to determine medical necessity.
• Communicate review results to care teams and stakeholders in accordance with regulatory requirements.
• Maintain accurate documentation and support policy adherence.
• Stay current with CMS, State, and NCQA requirements.

Skills

Utilization Management

Independent work

Communication skills

Collaboration

Education

RN - Associate's Degree

RN License (Massachusetts)

CCM certification

Job description

Sagility is hiring an RN Utilization Management Reviewer for a fully remote, home-based role in the United States. You will perform day-to-day clinical and service authorization reviews for medical necessity and ensure compliance with CMS standards.

Qualified candidates hold an MA RN license with an Associate's degree, and 1–2 years of UM experience in a clinical setting. CCM is a plus; strong communication and teamwork skills are essential.