Remote Utilization Review RN Specialist

R1 RCM; Tennessee; Hybrid; USD 65,000 - 97,000; Full time

Job summary

R1 RCM is seeking an experienced Utilization Review Author (RN) for our Physician Advisory Team. The role involves first-level admission and continued stay reviews using InterQual/MCG criteria and requires hospital-based UR or Case Management experience.

The position offers a flexible schedule with some weekend work and a target annual bonus. Candidates must hold an active RN license and a Bachelor's degree, with strong analytical and communication skills.

Qualifications

• Must have a current Registered Nurse license in your state of residence.
• Bachelor’s Degree is required.
• At least 2 years of recent hospital-based Utilization or Case Management Experience is preferred.
• At least 3 years of clinical nursing experience (practice).
• Knowledge of current Medicare rules and regulations related to Utilization Review.
• Strong analytical, organizational and time management skills.
• Ability to work independently with limited supervision.
• Excellent written and verbal communication skills.
• Excellent clinical abstraction and attention to detail.
• Experience with InterQual and/or MCG is preferred.
• Must be willing to work a variable schedule including evenings, days, weekends, and holidays (7:00 AM-12:00 AM EST).

Responsibilities

• Perform initial admission and continued stay reviews utilizing InterQual and MCG using evidenced-based criteria.
• Abstract data from medical records to ensure accurate clinical data.
• Adhere to established quality, timeliness, and productivity outputs for first-level nursing utilization review.
• Ensure effective communication internally and externally while delivering excellent customer service.
• Participate in system testing, training and other opportunities that promote growth.
• Complete and maintain annual compliance and annual HIPAA training.
• Participate in organizational educational offerings and required training as needed.

Skills

Analytical skills

Organizational skills

Time management

Written and verbal communication

Independent work

Attention to detail

Education

Bachelor’s Degree

Tools

InterQual

MCG

Job description

R1 RCM is seeking an experienced Utilization Review Author (RN) for our Physician Advisory Team. The role involves first-level admission and continued stay reviews using InterQual/MCG criteria and requires hospital-based UR or Case Management experience.

The position offers a flexible schedule with some weekend work and a target annual bonus. Candidates must hold an active RN license and a Bachelor's degree, with strong analytical and communication skills.