Remote Utilization Review Nurse (RN)

Leave Your Mark; Michigan; Remote; USD 70,000 - 100,000; Full time

Benefits offered by this job

401(k)

Paid vacation time

Career growth opportunities

Competitive compensation

Job summary

Leave Your Mark is seeking a Registered Nurse for Utilization Review to support a Michigan health plan client from a home-based setting. The role focuses on prospective, concurrent, and retrospective reviews to determine medical necessity, level of care, and length of stay for various services.

You will apply clinical judgment and evidence-based criteria, work with the medical director when needed, and ensure documentation meets accreditation and regulatory standards.

Qualifications

• Bachelor of Science in Nursing (BSN) preferred; ADN with relevant experience considered.
• Ability to maintain licensure and, where applicable, eligibility for multi-state licensure.
• Proficient with using technology including MS Office Applications, PDF, and Office.

Responsibilities

• Review, research, and authorize requests for elective, direct, and urgent services using approved criteria.
• Coordinate with medical staff to identify alternatives per client protocols.
• Evaluate documentation against MCG/InterQual criteria and CMS guidance.
• Document all review activity and determinations in the UR system.
• Support discharge-planning needs and coordinate referrals with care management.
• Communicate with providers and facilities to obtain records and convey approvals.
• Maintain confidentiality and HIPAA compliance and participate in IRR where required.

Skills

Critical thinking

Team player

Communication skills

Multitasking

Education

BSN preferred

ADN with experience considered

Tools

MS Office

PDF workflows

Job description

Leave Your Mark is seeking a Registered Nurse for Utilization Review to support a Michigan health plan client from a home-based setting. The role focuses on prospective, concurrent, and retrospective reviews to determine medical necessity, level of care, and length of stay for various services.

You will apply clinical judgment and evidence-based criteria, work with the medical director when needed, and ensure documentation meets accreditation and regulatory standards.