Remote Utilization Review Nurse — Growth & Flexible Hours

Gainwell Technologies LLC; North Carolina; Remote; USD 65,000 - 78,000; Full time

Benefits offered by this job

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Leadership and development academies

Job summary

Gainwell Technologies LLC is seeking a skilled Utilization Review Nurse for a remote role based in the United States. The position reviews medical necessity and appropriateness of services, using InterQual/MCG criteria and contract guidelines, with documentation in management systems.

Core hours are 8:00 AM - 6:00 PM ET, with potential extended hours and up to 10% travel. Benefits include flexible vacation, 401(k) match, health benefits, and professional development opportunities.

Qualifications

• Active RN license.
• 3+ years inpatient clinical experience.
• 1+ year in prior authorization reviews using InterQual or MCG.
• Strong written communication 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 license

Inpatient clinical experience

Prior authorization reviews

Written communication

Microsoft Office

Education

RN degree

Job description

Gainwell Technologies LLC is seeking a skilled Utilization Review Nurse for a remote role based in the United States. The position reviews medical necessity and appropriateness of services, using InterQual/MCG criteria and contract guidelines, with documentation in management systems.

Core hours are 8:00 AM - 6:00 PM ET, with potential extended hours and up to 10% travel. Benefits include flexible vacation, 401(k) match, health benefits, and professional development opportunities.