Remote Utilization Review RN: Expert Case Assessment

Medica; United States; On-site; USD 70,000 - 120,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

PTO

Job summary

Medica is a nonprofit health plan delivering coordinated, quality care to members across multiple states. The Utilization Review RN role focuses on reviewing prior authorization requests, documenting member histories, and applying clinical judgment to determine benefits in line with policies.

This remote position requires an RN license and 5+ years of experience beyond degree, with an associate or bachelor's degree preferred.

Qualifications

• Attention to detail and clinical judgment applied to determine benefits.
• Review of prior authorization requests and member case histories.
• Ability to work with multiple departments and providers.

Responsibilities

• Review and document member case history for prior authorization decisions.
• Analyze trends and contribute to policy updates for UM processes.
• Interface with members, providers, clinics, and internal teams to support utilization review.

Skills

Attention to detail

Clinical judgment

Education

RN license

Associate's or Bachelor's degree or equivalent experience

Tools

EHR systems

Job description

Medica is a nonprofit health plan delivering coordinated, quality care to members across multiple states. The Utilization Review RN role focuses on reviewing prior authorization requests, documenting member histories, and applying clinical judgment to determine benefits in line with policies.

This remote position requires an RN license and 5+ years of experience beyond degree, with an associate or bachelor's degree preferred.