Remote Utilization Management RN — Contract

Yoh Services LLC; Philadelphia (Philadelphia County); On-site; USD 44,000 - 62,000; Full time

Benefits offered by this job

Medical, Prescription, Dental & Vision

HSA

Life & Disability Insurance

401K Retirement Savings Plan

Direct Deposit & weekly epayroll

Referral Bonus Programs

Certification and training

Job summary

Yoh Services LLC is seeking a remote UM case management professional for a contract opportunity supporting a Philadelphia-based insurance client. The role reviews medical records to determine medical necessity, communicates with providers, and ensures regulatory compliance while acting as a patient advocate.

Candidates must reside in PA/DE/NJ tri-state area and hold PA RN licensure or Nurse Licensure Compact. Schedule is Mon-Fri, 8:45am-5pm, with 9/14 to 12/14 term and pay $32–$45 per hour, DOE.

Qualifications

• Current, active Pennsylvania Registered Nurse licensure.
• UM experience in outpatient or inpatient settings.
• Ability to determine medical necessity using established criteria.

Responsibilities

• Review medical records to determine medical necessity for services.
• Communicate with providers to clarify treatment plans and medical need.
• Ensure regulatory compliance and appropriate utilization management.
• Coordinate with case management staff and Medical Director as needed.
• Document all actions accurately in the care management system.
• Meet regulatory turnaround times and productivity goals.

Skills

RN licensure

UM experience

Regulatory knowledge

Clinical decision making

Job description

Yoh Services LLC is seeking a remote UM case management professional for a contract opportunity supporting a Philadelphia-based insurance client. The role reviews medical records to determine medical necessity, communicates with providers, and ensures regulatory compliance while acting as a patient advocate.

Candidates must reside in PA/DE/NJ tri-state area and hold PA RN licensure or Nurse Licensure Compact. Schedule is Mon-Fri, 8:45am-5pm, with 9/14 to 12/14 term and pay $32–$45 per hour, DOE.