Remote Utilization Review Nurse | Case Management & Appeals

Community Health Systems, Inc.; United States; Remote; USD 70,000 - 100,000; Part time

Job summary

Community Health Systems, Inc. is seeking a PRN Remote Clinical Utilization Review Specialist to evaluate medical necessity and efficiency of hospital services.

You will support admissions and continued stays, assist with denials and appeals, and collaborate with clinicians to meet payer requirements and maintain regulatory compliance. You will document activities in case management software and EHR, coordinate with insurers, and identify opportunities to optimize hospital resource use.

Qualifications

• Minimum 2–4 years of clinical experience in utilization review, case management or acute care nursing.
• Experience with payer requirements and hospital revenue cycle is preferred.

Responsibilities

• Perform admission and continued stay reviews using evidence-based criteria.
• Collaborate with physicians and clinical teams for documentation of medical necessity.
• Document all utilization review activities in case management software and EHR.
• Work with insurers to obtain coverage approvals and manage denials.
• Communicate with utilization review personnel to support patient care.
• Analyze admission trends and identify process improvements.

Skills

Utilization management

Payer guidelines

Case management software

Communication

HIPAA compliance

Education

Technical School in Practical Nursing

Associate Degree in Nursing

Tools

Case management software

EHR systems

Job description

Community Health Systems, Inc. is seeking a PRN Remote Clinical Utilization Review Specialist to evaluate medical necessity and efficiency of hospital services.

You will support admissions and continued stays, assist with denials and appeals, and collaborate with clinicians to meet payer requirements and maintain regulatory compliance. You will document activities in case management software and EHR, coordinate with insurers, and identify opportunities to optimize hospital resource use.