Remote RN Utilization Review Specialist

NurseRemotely; United States; Remote; USD 65,000 - 75,000; Full time

Job summary

WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant patient care. The role emphasizes adherence to HIPAA, state and federal regulations, and a strong team-oriented environment.

Requirements include active RN or LVN licensure, a minimum of two years in utilization review or related fields, and proficiency with Microsoft Office and healthcare software.

Qualifications

• RN or LVN license active and unrestricted in the U.S.
• Minimum of two years in utilization review, case management, or clinical quality improvement
• Proficient in Word, Excel, and PowerPoint; able to learn healthcare software quickly

Responsibilities

• Performs utilization review of cases to determine medical necessity according to policies
• Facilitates resolution of escalated cases requiring special handling
• Maintains documentation in accordance with policies and regulatory requirements
• Interacts with providers and staff to resolve concerns and ensure appropriate care decisions
• Adheres to HIPAA and state/federal regulations; supports quality management

Skills

Communication skills

Time management

Critical thinking

Independent worker

Team collaboration

Education

RN/LVN licensure

Tools

Microsoft Office

Healthcare software

Job description

WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant patient care. The role emphasizes adherence to HIPAA, state and federal regulations, and a strong team-oriented environment.

Requirements include active RN or LVN licensure, a minimum of two years in utilization review or related fields, and proficiency with Microsoft Office and healthcare software.