Remote Utilization Management RN: Inpatient & Post-Acute

Devoted; Northern (KY); Hybrid; USD 83,000 - 96,000; Full time

Benefits offered by this job

Health plan

Paid time off

Mobile/internet stipend

Stock options

Bonus eligibility

401K

Job summary

Devoted Health is seeking a Clinical Guide Part A to support inpatient, behavioral health, and post-acute utilization review in alignment with CMS guidelines. This remote, full-time role requires a licensed RN with several years of UR experience and familiarity with Medicare Advantage requirements.

The position offers multiple schedules including weekend coverage and emphasizes regulatory compliance and collaboration with Medical Directors to ensure timely, appropriate care.

Qualifications

• Unrestricted RN license and at least 4 years of clinical experience.
• 3+ years in utilization review, utilization management, case management, discharge planning, care coordination, or clinical appeals.
• Familiarity with CMS regulations and Medicare Advantage requirements.
• Ability to work one of the posted schedules, including weekend days; flexible across schedules.

Responsibilities

• Review Medical Records: pre-service, concurrent, and retrospective utilization review per CMS guidelines.
• Evaluate Treatment Plans: assess appropriateness, timing, and setting of requested services.
• Inpatient & Behavioral Health Review: perform initial, concurrent, and discharge reviews with CMS timeliness.
• Post-Acute Review: authorize and review SNF, LTACH, ARU, Home Health; assess length of stay.
• Coordinate with Medical Director for secondary review and peer-to-peer discussions.
• Monitor resource use to ensure high-quality, member-centered care.
• Maintain documentation in compliance with CMS and internal standards.

Skills

RN license

Utilization review

CMS regulations

InterQual certification

Regulatory compliance

Education

Registered Nurse degree

Tools

InterQual Tools

Job description

Devoted Health is seeking a Clinical Guide Part A to support inpatient, behavioral health, and post-acute utilization review in alignment with CMS guidelines. This remote, full-time role requires a licensed RN with several years of UR experience and familiarity with Medicare Advantage requirements.

The position offers multiple schedules including weekend coverage and emphasizes regulatory compliance and collaboration with Medical Directors to ensure timely, appropriate care.