Remote Utilization Review Nurse (PRN)

Dane Street; United States; On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401k with company match

Remote workspace equipment stipend

Paid time off and holidays

Job summary

Dane Street is seeking an Utilization Management Nurse Reviewer to ensure medical services are efficient and appropriate. PRN staffing supports peak times, weekends, and holidays with required weekend and holiday coverage.

The role requires active LPN/LVN or RN credentials, strong clinical judgment, and excellent communication. Work-from-home readiness, with benefits and a comprehensive package, are provided.

Qualifications

• Strong written and spoken communication skills for interactions with physicians, clients, and staff.
• Ability to manage multiple tasks in a dynamic office setting with attention to detail.
• Solid clinical knowledge and understanding of utilization management processes.
• Familiarity with regulatory guidelines and health plan criteria is preferred.
• Experience using Microsoft Word, Excel, PowerPoint, and Outlook.

Responsibilities

• Conduct assessments of medical services to validate appropriateness using established criteria.
• Examine patient records to verify quality of care and necessity of services.
• Provide clinical expertise and act as a reference for non-clinical staff.
• Input and manage clinical details within medical management platforms.
• Stay updated on URAC and state requirements for utilization review.
• Apply evidence-based guidelines to determine suitable care pathways.
• Collaborate with management, physicians, and Medical Director to improve patient care.

Skills

Communication skills

Multitasking

Clinical knowledge

Regulatory knowledge

Education

LVN/LPN license

RN license or nursing degree

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Outlook

Job description

Dane Street is seeking an Utilization Management Nurse Reviewer to ensure medical services are efficient and appropriate. PRN staffing supports peak times, weekends, and holidays with required weekend and holiday coverage.

The role requires active LPN/LVN or RN credentials, strong clinical judgment, and excellent communication. Work-from-home readiness, with benefits and a comprehensive package, are provided.