Remote RN – Utilization Review & Case Management Specialist

Jobgether; Provo (UT); Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Remote work: Full-time

Paid time off

Retirement plans

Professional development support

Job summary

Jobgether is partnering with a U.S.-based healthcare employer to recruit a Case Manager – Utilization Review Specialist for a fully remote role in the United States. The position focuses on admission and concurrent reviews, medical necessity determinations, and coordination of multi-level appeals to support appropriate patient care and financial performance.

The role leverages clinical nursing expertise, analytical thinking, and strong communication to improve review processes.

Qualifications

• Active RN license in the United States is required.
• Minimum five years of clinical nursing experience in an acute care setting.
• Five to seven years of experience in case management, discharge planning, utilization review, or related healthcare discipline preferred.
• Strong knowledge of utilization management practices, payer requirements, and regulatory standards.

Responsibilities

• Conduct admission and concurrent utilization reviews to assess medical necessity and length of stay.
• Identify potential reimbursement denials and develop strategies to prevent recurring issues.
• Coordinate first-, second-, and third-level appeals with complete documentation.
• Draft professional appeal letters supported by clinical evidence and payer policies.
• Monitor appeal timelines and outcomes and report to stakeholders.

Skills

Analytical thinking

Written communication

Verbal communication

Interpersonal skills

Independent work

Time management

Education

Registered Nurse (RN) license

Job description

Jobgether is partnering with a U.S.-based healthcare employer to recruit a Case Manager – Utilization Review Specialist for a fully remote role in the United States. The position focuses on admission and concurrent reviews, medical necessity determinations, and coordination of multi-level appeals to support appropriate patient care and financial performance.

The role leverages clinical nursing expertise, analytical thinking, and strong communication to improve review processes.