Remote Utilization Review Nurse | Case Management Pro

SuitCASES; New York (NY); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

Health insurance

401(k) plan

Paid holidays

Vacation pay

Job summary

Medovent Solutions is seeking experienced Utilization Review Nurses for opportunities with leading healthcare organizations throughout the Southeast. These positions are ideal for professionals who want to apply clinical expertise to patient care, medical necessity, and efficient delivery.

Opportunities may be remote, onsite, local, or travel-based depending on assignment requirements. The successful candidate will be an experienced Registered Nurse able to review complex information and

Qualifications

• Current, unrestricted Registered Nurse license.
• Experience in Utilization Review and Case Management.
• Experience using Epic.
• Experience applying MCG or comparable utilization review criteria.
• Strong knowledge of medical necessity, level-of-care, and utilization management practices.
• Ability to interpret complex medical records, clinical findings, and supporting documentation.
• Strong clinical judgment, critical-thinking, organizational, and communication skills.

Responsibilities

• Perform prospective, concurrent, and retrospective utilization reviews as required by the assignment.
• Review clinical documentation to determine medical necessity and the appropriate level of care.
• Apply MCG and other established clinical criteria consistently and accurately.
• Evaluate admission, continued-stay, and level-of-care documentation.
• Identify potential authorization, medical necessity, and utilization concerns.
• Collaborate with physicians, physician advisors, case managers, clinical teams, and other healthcare professionals.
• Escalate cases requiring additional review or intervention through the appropriate channels.
• Maintain complete, accurate, and timely documentation within Epic and applicable utilization management systems.
• Support compliance with organizational policies, payer requirements, and applicable federal and state regulations.
• Meet established expectations for review quality, productivity, accuracy, and timely case completion.
• Protect patient confidentiality and comply with all applicable privacy requirements.
• Adapt to the workflows, policies, and operational needs of each assigned healthcare environment.

Skills

RN License

Utilization Review

Case Management

Medical records interpretation

Clinical judgment

Communication

Independent work

Tools

Epic

MCG Criteria

Job description

Medovent Solutions is seeking experienced Utilization Review Nurses for opportunities with leading healthcare organizations throughout the Southeast. These positions are ideal for professionals who want to apply clinical expertise to patient care, medical necessity, and efficient delivery.

Opportunities may be remote, onsite, local, or travel-based depending on assignment requirements. The successful candidate will be an experienced Registered Nurse able to review complex information and