Remote Utilization Management RN Consultant (Canada)

Jobgether; United States; Remote; USD 40,000 - 86,000; Full time

Benefits offered by this job

Fully remote

40 hours per week

Competitive base pay

Bonus eligibility

Benefits package

Job summary

Jobgether, on behalf of a partner organization, seeks an experienced Registered Nurse for a remote Utilization Management role. You will review cases, assess medical necessity, and support prior authorization decisions while collaborating with providers and interdisciplinary teams.

The ideal candidate has 3+ years RN experience, ADN required with BSN preferred, and strong clinical judgment. This is a fully remote, 40-hour-per-week role with HIPAA-compliant security expectations.

Qualifications

• Active, unrestricted RN license in the state of residence.
• Minimum of 3 years RN experience.
• ADN required; BSN preferred.
• Strong clinical assessment and decision-making skills.
• Proficiency with Microsoft Office applications (Outlook, Excel).
• Able to work Monday–Friday 9:00–17:30 in local time zone with some flexibility.
• Experience in utilization management or prior authorization is preferred.

Responsibilities

• Review clinical documentation to make utilization management determinations using evidence-based criteria.
• Apply clinical judgment to evaluate medical necessity and support prior authorization decisions.
• Collaborate with providers and care teams to support treatment planning and care coordination.
• Ensure members receive appropriate care in the right setting and time.
• Identify opportunities to improve clinical outcomes and operational processes.
• Serve as a clinical resource for internal colleagues and external providers.
• Navigate healthcare applications to review documentation and manage cases.

Skills

Clinical assessment

Critical thinking

Microsoft Office

VPN access

Remote work

Education

ADN

BSN preferred

Tools

MedCompass

Microsoft 365

VPN tools

Job description

Jobgether, on behalf of a partner organization, seeks an experienced Registered Nurse for a remote Utilization Management role. You will review cases, assess medical necessity, and support prior authorization decisions while collaborating with providers and interdisciplinary teams.

The ideal candidate has 3+ years RN experience, ADN required with BSN preferred, and strong clinical judgment. This is a fully remote, 40-hour-per-week role with HIPAA-compliant security expectations.