Remote Utilization Management Nurse – Part-Time Weekend

Rxadvance Corporation; Southborough (MA); Remote; USD 52,000 - 55,000; Part time

Job summary

nirvanaHealth, a RxAdvance Corp. company, seeks a part-time Utilization Management Nurse for a remote role in the United States. You will perform prospective, concurrent, and retrospective medical necessity reviews and care coordination to ensure quality, cost efficiency, and regulatory compliance.

This position requires an Associate's degree in nursing, active RN licensure, and 0–2 years in UM or case management. Schedule is 12 hours per week: Fri 4 hours, Sat 4 hours, Sun 4 hours.

Qualifications

• Associate's degree in nursing required.
• Bachelor's degree in nursing preferred.
• 0-2 years in utilization management or case management preferred.
• US RN licensure required; knowledge of Medicare/Medicaid/URAC preferred.

Responsibilities

• Performs prospective, concurrent, and retrospective medical necessity reviews.
• Determines level of care and monitors length of stay.
• Conducts initial clinical review per accreditation and regulations.
• Ensures timeliness of medical necessity reviews and accurate coding.

Skills

Nursing clinical judgment

Team collaboration

Education

Associate's degree in nursing

Bachelor’s degree in nursing

Tools

MS Word

Excel

Access

PowerPoint

Job description

nirvanaHealth, a RxAdvance Corp. company, seeks a part-time Utilization Management Nurse for a remote role in the United States. You will perform prospective, concurrent, and retrospective medical necessity reviews and care coordination to ensure quality, cost efficiency, and regulatory compliance.

This position requires an Associate's degree in nursing, active RN licensure, and 0–2 years in UM or case management. Schedule is 12 hours per week: Fri 4 hours, Sat 4 hours, Sun 4 hours.