Remote RN: Utilization Review & Care Decisions

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

Benefits offered by this job

Medical

Dental

Vision

Life Insurance

Short-Term Disability

Long-Term Disability

Flexible Spending Account

Life Assistance Program

401K with employer contribution

PTO and Sick Time

Tuition Reimbursement

Job summary

Sagility is hiring an RN Utilization Management Reviewer to perform day-to-day clinical and service authorization reviews for medical necessity, ensuring CMS compliance in decision-making.

Requires RN license in Massachusetts, Associate degree minimum (Bachelor's preferred), 1–2 years in Utilization Management and 2+ years in a clinical setting; CCM a plus.

This fully remote US-based role offers competitive benefits, M-F 9:00–5:30 ET, and a salary of $35–$40 hourly, with potential weekend shifts.

Qualifications

• RN with an associate degree required; bachelor’s degree preferred.
• Current RN license issued by the Massachusetts Board of Registration in Nursing.
• CCM certification is a plus.

Responsibilities

• Perform day-to-day timely clinical and service authorization reviews for medical necessity and decision-making.
• Ensure CMS compliance standards in service decisions and organizational determinations.

Skills

Nursing license

Utilization management

Clinical experience

Home health care

Medicare Advantage

Independence

InterQual

Education

RN Associate's Degree

RN license (Massachusetts)

CCM certification (a plus)

Tools

InterQual

Medical Necessity Guidelines

Job description

Sagility is hiring an RN Utilization Management Reviewer to perform day-to-day clinical and service authorization reviews for medical necessity, ensuring CMS compliance in decision-making.

Requires RN license in Massachusetts, Associate degree minimum (Bachelor's preferred), 1–2 years in Utilization Management and 2+ years in a clinical setting; CCM a plus.

This fully remote US-based role offers competitive benefits, M-F 9:00–5:30 ET, and a salary of $35–$40 hourly, with potential weekend shifts.