Remote RN Utilization Manager - Acute Care & Discharge Expert

ML OUTSOURCING SERVICES PRIVATE LIMITED; United States; On-site; USD 85,000 - 110,000; Full time

Job summary

ML OUTSOURCING SERVICES PRIVATE LIMITED is seeking a remote Registered Nurse for a 6+ month engagement with extension potential. You will perform concurrent reviews, assess medical necessity, and support discharge planning for inpatient and rehabilitation cases.

The role requires 2+ years in acute care and utilization management, with familiarity with InterQual/MCG guidelines. You will document findings, educate providers, and ensure compliant care transitions while working fully remotely from

Qualifications

• Active RN license in good standing.
• 2+ years in acute care nursing.
• 2-4 years in Utilization Management, Prior Authorization or Case Management.

Responsibilities

• Perform concurrent reviews to assess health status, determine medical necessity, and support discharge planning.
• Review inpatient hospital and rehab cases for Dual Eligible (Medicare/Medicaid) members.
• Document findings and discharge plans per utilization management policies.
• Provide education to providers on utilization management processes and requirements.
• Conduct real-time concurrent reviews to ensure appropriate care and resource use.
• Apply InterQual/MCG or similar criteria to support authorization decisions.

Skills

RN license

Utilization review

Care coordination

Education

BSN or equivalent

Job description

ML OUTSOURCING SERVICES PRIVATE LIMITED is seeking a remote Registered Nurse for a 6+ month engagement with extension potential. You will perform concurrent reviews, assess medical necessity, and support discharge planning for inpatient and rehabilitation cases.

The role requires 2+ years in acute care and utilization management, with familiarity with InterQual/MCG guidelines. You will document findings, educate providers, and ensure compliant care transitions while working fully remotely from