Remote Utilization Review Nurse

Gainwell Technologies; Alaska; Hybrid; USD 78,000 - 88,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Flexible vacation policy

Job summary

Gainwell Technologies is seeking a skilled Utilization Review Nurse to perform prior authorization across prospective, concurrent, and retrospective reviews for medical necessity, documenting findings and ensuring policy compliance. This home-based role supports providers, uses InterQual/MCG criteria, requires 3+ years inpatient experience and an active RN license in the U.S.

Core hours 8:00 AM–6:00 PM ET; occasional travel up to 10%; salary range $78,000–$88,000 with benefits.

Qualifications

• Active, unrestricted RN licensure in the U.S. and a primary state of residence, plus an active compact multistate RN license as defined by the Nurse Licensure Compact (NLC); verification required during post-offer background check.
• 3+ years of inpatient clinical experience.
• 1+ year in prior authorization reviews using InterQual or MCG.
• Strong written communication skills in a fast-paced setting.
• Proficient in Microsoft Office and other computer applications.

Responsibilities

• Review admissions, procedures, services, and supplies for medical necessity and appropriateness, meeting quality and production goals.
• Use clinical criteria for decision-making, referring complex cases to Medical Directors when needed.
• Engage with providers to gather clinical information, apply guidelines, and make determinations.
• Document findings and rationale in medical management systems.
• Assist in training new nurses, provide feedback, and stay updated on clinical guidelines.
• Maintain RN license and meet continuing education requirements.

Skills

RN licensure in US

Inpatient clinical experience

Prior authorization reviews (InterQual

Tools

Microsoft Office

Job description

Gainwell Technologies is seeking a skilled Utilization Review Nurse to perform prior authorization across prospective, concurrent, and retrospective reviews for medical necessity, documenting findings and ensuring policy compliance. This home-based role supports providers, uses InterQual/MCG criteria, requires 3+ years inpatient experience and an active RN license in the U.S.

Core hours 8:00 AM–6:00 PM ET; occasional travel up to 10%; salary range $78,000–$88,000 with benefits.