RN Utilization Management Care Reviewer

The Judge Group; Phoenix (AZ); Remote; Full time

Job summary

A leading healthcare organization is seeking a Utilization Management Nurse to ensure quality patient care through evidence-based guidelines. This role involves collaboration with providers and service teams, overseeing reviews and managing resource utilization. The ideal candidate will have a nursing degree, RN license, and extensive clinical experience. This is a full-time contract position with remote work options available.

Qualifications

• Five years of clinical nursing experience or equivalent knowledge.
• Active, unrestricted State Registered Nursing (RN) license.

Responsibilities

• Assess inpatient services for cost-effectiveness and compliance.
• Analyze clinical service requests using evidence-based guidelines.
• Collaborate with multidisciplinary teams to promote integrated model.

Skills

Proficiency in Microsoft Suite

Electronic Medical Record (EMR) systems

Education

Bachelor’s degree in nursing

Job description

Direct message the job poster from The Judge Group

Lead Healthcare Recruiter at The Judge Group

Location: PHOENIX, AZ, USA

Salary: $45.00 USD Hourly - $50.00 USD Hourly

Description

Job Title: Utilization Management Nurse

Location: Remote

Job Type: Full Time Contract, 6+ months

About The Job

As a Utilization Management Nurse, you will play a critical role in determining the medical appropriateness of requested services. By reviewing clinical information and applying evidence-based guidelines, you will ensure quality patient care while optimizing outcomes. You will collaborate with providers, members, and service teams to obtain necessary information and communicate determinations efficiently. Additionally, you will oversee pre-service, admission, and concurrent review decisions while managing length of stay, discharge planning, and resource utilization.

Key Responsibilities

• Assess inpatient services to ensure cost-effectiveness and compliance with state and federal regulations.
• Analyze clinical service requests using evidence-based guidelines.
• Identify appropriate benefits, eligibility criteria, and expected length of stay for treatments.
• Conduct inpatient reviews to determine financial responsibility and process authorization requests within set timelines.
• Refer cases to Medical Directors and facilitate appropriate referrals to other clinical programs.
• Collaborate with multidisciplinary teams to promote the client's integrated model.
• Adhere to all Utilization Management policies, procedures, and professional standards.
  
  

Minimum Qualifications

• Education: Bachelor’s degree in nursing or equivalent experience.
• Licensure: Active, unrestricted State Registered Nursing (RN) license.
• Certification: MCG certification (or ability to obtain within six months of hire).
• Experience: Five years of clinical nursing experience or equivalent knowledge.
• Technical Skills: Proficiency in Microsoft Suite, electronic medical record (EMR) systems, and multiple platforms for medical record review.
  
  

Apply today for immediate consideration!

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Contact: [e-mail]

This job and many more are available through The Judge Group. Find us on the web at www.judge.com

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care and Medical Practices

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