Remote Utilization Review Case Manager – RN Expert

Jobgether; Carson City (NV); Remote; USD 90,000 - 120,000; Full time

Job summary

Jobgether, on behalf of a partner company, is seeking a Case Manager – Utilization Review Specialist for a remote US role. You will oversee admission and concurrent utilization reviews, assess medical necessity, and draft evidence-based appeals while coordinating with physicians, case managers, and payer representatives to protect patient care and optimize reimbursement outcomes.

The ideal candidate has 5+ years of clinical nursing and 5–7 years in case management or utilization review,

Qualifications

• Minimum 5 years of clinical nursing experience in acute care.
• 5–7 years in case management, discharge planning, utilization review, or related healthcare discipline preferred.
• Strong knowledge of utilization management practices, payer requirements, and regulatory standards.

Responsibilities

• Conduct admission and concurrent utilization reviews to assess medical necessity and length of stay.
• Identify potential denials and coordinate first-, second-, and third-level appeals with supporting documentation.
• Draft professional appeal letters with clinical evidence and payer policies.
• Maintain accurate documentation of reviews, denials, appeals, and outcomes in databases and billing systems.

Skills

clinical nursing

utilization review

case management

discharge planning

Education

RN license

Tools

InterQual

MCG guidelines

Job description

Jobgether, on behalf of a partner company, is seeking a Case Manager – Utilization Review Specialist for a remote US role. You will oversee admission and concurrent utilization reviews, assess medical necessity, and draft evidence-based appeals while coordinating with physicians, case managers, and payer representatives to protect patient care and optimize reimbursement outcomes.

The ideal candidate has 5+ years of clinical nursing and 5–7 years in case management or utilization review,