Remote Utilization Review Case Manager

Jobgether; Clifton (TX); Remote; USD 90,000 - 120,000; Full time

Job summary

Jobgether, in partnership with a healthcare team, seeks a Case Manager – Utilization Review Specialist based in the United States. This fully remote role focuses on admission and concurrent reviews, denials prevention, and coordinated appeals to support patient care and financial performance.

You will apply nursing expertise to evaluate records, determine medical necessity, and draft evidence-based appeals.

Qualifications

• Five years of clinical nursing experience in an acute care setting is required.
• Five to seven years of experience in case management, discharge planning, utilization review, or related healthcare discipline preferred.
• Strong knowledge of healthcare utilization management practices, payer requirements, reimbursement policies, and regulatory standards.

Responsibilities

• Conduct admission and concurrent utilization reviews to assess medical necessity and length of stay.
• Draft professional appeal letters supported by clinical evidence and payer policies.
• Coordinate first-, second-, and third-level appeals and ensure timely submissions.
• Maintain accurate documentation of reviews, denials, and appeal outcomes in databases and billing systems.
• Collaborate with physicians, nurses, case managers, medical directors, and payer representatives to resolve complex cases.

Skills

Utilization reviews

Case management

Clinical nursing

Written communication

Interpersonal skills

Job description

Jobgether, in partnership with a healthcare team, seeks a Case Manager – Utilization Review Specialist based in the United States. This fully remote role focuses on admission and concurrent reviews, denials prevention, and coordinated appeals to support patient care and financial performance.

You will apply nursing expertise to evaluate records, determine medical necessity, and draft evidence-based appeals.