Remote Utilization Review Nurse Auditor

ExamWorks, Inc.; United States; Remote; USD 70,000 - 110,000; Full time

Benefits offered by this job

Medical benefits

401k

Paid time off

Job summary

ExamWorks, LLC is seeking a Utilization Review Nurse Auditor to join our remote team. The role requires an active RN/LPN/LVN license and 3–5 years of direct patient care experience, with strong knowledge of medical terminology and treatment protocols.

You will conduct quality utilization reviews and ensure compliance with URAC, ERISA and client requirements. The position is fully remote with a standard M-F schedule 8:00am–5:00pm EST.

Qualifications

• Active unencumbered RN/LPN/LVN license required.
• 3–5 years of direct professional patient care experience.
• Graduate of an accredited nursing program; bachelor’s degree preferred.
• Strong knowledge of medical terminology, anatomy and physiology, treatment protocols, medications and labs.

Responsibilities

• Perform quality utilization review using evidenced based guidelines for peer review reports, correspondences, addendums and/or supplemental reviews.
• Identify level, intensity and duration of care with providers.
• Document findings and evaluate medical necessity for frequency, intensity and length of care.
• Ensure reviews meet industry standards and client, regulatory requirements.

Skills

Medical terminology

Attention to detail

Independent work

Time management

Communication skills

Education

Nursing degree (RN/LPN/LVN)

Active nursing license

Tools

Microsoft Office

Job description

ExamWorks, LLC is seeking a Utilization Review Nurse Auditor to join our remote team. The role requires an active RN/LPN/LVN license and 3–5 years of direct patient care experience, with strong knowledge of medical terminology and treatment protocols.

You will conduct quality utilization reviews and ensure compliance with URAC, ERISA and client requirements. The position is fully remote with a standard M-F schedule 8:00am–5:00pm EST.