Remote Utilization Management RN – AI-Driven Reviews

Guidehealth; Davenport (IA); On-site; USD 70,000 - 75,000; Full time

Benefits offered by this job

Work from Home

Health, Dental, Vision

401(k) with employer match

Life & Disability Insurance

Employee Assistance Program

Paid Time Off

Paid Parental Leave

Learning & Development

Job summary

Guidehealth is a fully remote healthcare company focused on using AI and predictive analytics to improve patient outcomes and value-based care. The Utilization Management Registered Nurse will conduct reviews, document findings, and collaborate with medical leadership to guide care decisions across multiple jurisdictions.

The role emphasizes compliance with URAC standards, regulatory requirements, and ongoing professional development while leveraging AI in daily workflows.

Qualifications

• Registered Nurse with an active Illinois license.
• Three years of experience in various healthcare settings.
• Knowledge of utilization review, managed care, and community health.
• CE: 20 hours per 2-year license renewal cycle.
• Proficiency with Microsoft 365 (Word, Excel, PowerPoint).

Responsibilities

• Perform utilization reviews (precertification and concurrent) using approved criteria.
• Document clinical findings and determinations per standards.
• Communicate review outcomes to providers, members, and other parties within timeframes.
• Collaborate with Medical Director and Peer Reviewers on complex cases.
• Integrate AI tools into daily workflow and provide feedback.

Skills

Utilization review

Registered Nurse

Healthcare experience

URAC standards

Microsoft 365

Organizational writing

Communication skills

AI integration

Education

RN license (Illinois)

Tools

Microsoft 365

Job description

Guidehealth is a fully remote healthcare company focused on using AI and predictive analytics to improve patient outcomes and value-based care. The Utilization Management Registered Nurse will conduct reviews, document findings, and collaborate with medical leadership to guide care decisions across multiple jurisdictions.

The role emphasizes compliance with URAC standards, regulatory requirements, and ongoing professional development while leveraging AI in daily workflows.