Remote RN Utilization Review Auditor

ExamWorks; United States; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical, vision, dental benefits

Paid time off

401k

Job summary

ExamWorks is seeking a Utilization Review Nurse Auditor for a 100% remote role. The position requires a nursing license and 3–5 years of direct patient care.

You will perform quality utilization reviews, determine medical necessity, and ensure timely determination letters in compliance with URAC and federal/state guidelines. The role emphasizes collaboration with providers, accurate documentation, and adherence to client contracts.

Qualifications

• Active unencumbered RN, LPN or LVN required.
• Strong knowledge of medical terminology, anatomy and physiology, treatment protocols, medications and laboratory values.
• Experience in utilization management preferred.

Responsibilities

• Perform quality utilization review using evidentiary guidelines for peer review reports and addendums.
• Work with providers to identify level, intensity and duration of care.
• Document findings and evaluate medical necessity for care frequency and length.
• Ensure reviews meet URAC and regulatory turnaround times.
• Maintain URAC knowledge and regulatory compliance.
• Maintain accurate utilization review records in the database.
• Direct customer service to ensure timely delivery of determination letters.

Skills

RN/LPN/LVN

Healthcare terminology

Medical terminology

Analytical skills

Education

Nursing degree

High school diploma

Job description

ExamWorks is seeking a Utilization Review Nurse Auditor for a 100% remote role. The position requires a nursing license and 3–5 years of direct patient care.

You will perform quality utilization reviews, determine medical necessity, and ensure timely determination letters in compliance with URAC and federal/state guidelines. The role emphasizes collaboration with providers, accurate documentation, and adherence to client contracts.