Remote Utilization Management RN: Autonomous, Impactful

The Rector & Visitors of the University of Virginia; Charlottesville (VA); Remote; USD 76,000 - 122,000; Full time

Benefits offered by this job

Vision insurance

Paid time off

Relocation assistance

Job summary

UVA Health is seeking a Registered Nurse (RN) in Utilization Management for a remote role. You will leverage acute care experience to navigate complex clinical scenarios, determine medical necessity, and collaborate with interdisciplinary teams.

This position offers a Monday–Friday schedule (8:00 AM – 4:30 PM), no on-call or weekend rotations, and relocation assistance. The role supports regulatory compliance and payer strategies across CMS and Medicare guidelines.

Qualifications

• Bachelor of Science in Nursing required.
• 2 years acute care hospital experience required.

Responsibilities

• Review patient admissions to determine medical necessity and level of care.
• Evaluate whether patients are placed in the correct admission status and timeframe.
• Ensure adherence to CMS, Medicare, and payer guidelines.
• Communicate with physicians, nurses, and care teams to clarify or adjust patient status as needed.
• Engage with insurance payers to support authorization and reimbursement processes.
• Identify and act on opportunities to maintain compliance and optimize outcomes.

Skills

Acute care experience

Regulatory compliance

Education

Bachelor of Science in Nursing

Job description

UVA Health is seeking a Registered Nurse (RN) in Utilization Management for a remote role. You will leverage acute care experience to navigate complex clinical scenarios, determine medical necessity, and collaborate with interdisciplinary teams.

This position offers a Monday–Friday schedule (8:00 AM – 4:30 PM), no on-call or weekend rotations, and relocation assistance. The role supports regulatory compliance and payer strategies across CMS and Medicare guidelines.