Utilization Review Nurse- Remote at Gainwell Technologies LLC North Carolina

Gainwell Technologies LLC; North Carolina; Remote; USD 65,000 - 78,000; Full time

Benefits offered by this job

Flexible vacation policy

401(k) employer match

Comprehensive health benefits

Educational assistance

Leadership and development academies

Job summary

Gainwell Technologies LLC is seeking a skilled Utilization Review Nurse for a remote role based in the United States. The position reviews medical necessity and appropriateness of services, using InterQual/MCG criteria and contract guidelines, with documentation in management systems.

Core hours are 8:00 AM - 6:00 PM ET, with potential extended hours and up to 10% travel. Benefits include flexible vacation, 401(k) match, health benefits, and professional development opportunities.

Qualifications

• Active RN license.
• 3+ years inpatient clinical experience.
• 1+ year in prior authorization reviews using InterQual or MCG.
• Strong written communication in a fast-paced setting.
• Proficient in Microsoft Office and other computer applications.

Responsibilities

• Review admissions, procedures, services, and supplies for medical necessity and appropriateness, meeting quality and production goals.
• Use clinical criteria for decision-making, referring complex cases to Medical Directors when needed.
• Engage with providers to gather clinical information, apply guidelines, and make determinations.
• Document findings and rationale in medical management systems.
• Assist in training new nurses, provide feedback, and stay updated on clinical guidelines.
• Maintain RN license and meet continuing education requirements.

Skills

RN license

Inpatient clinical experience

Prior authorization reviews

Written communication

Microsoft Office

Education

RN degree

Job description

Utilization Review Nurse- Remote job at Gainwell Technologies LLC. North Carolina.

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

We are seeking a skilled Utilization Review Nurse to conduct prior authorization, prospective, concurrent, and retrospective reviews for medical necessity and appropriateness of services, following clinical criteria, coverage policies, and contract guidelines. This involves reviewing medical documentation, accurately documenting findings, and ensuring policy compliance.

Your role in our mission

• Review admissions, procedures, services, and supplies for medical necessity and appropriateness, meeting quality and production goals.
• Use clinical criteria for decision-making, referring complex cases to Medical Directors when needed.
• Engage with providers to gather clinical information, apply guidelines, and make determinations.
• Document findings and rationale in medical management systems.
• Assist in training new nurses, provide feedback, and stay updated on clinical guidelines.
• Maintain RN license and meet continuing education requirements.

What we're looking for

• Active RN license.
• 3+ years of inpatient clinical experience.
• 1+ year in prior authorization reviews using InterQual or MCG.
• Strong written communication skills in a fast-paced setting.
• Proficient in Microsoft Office and other computer applications.

What you should expect in this role

• Home-based position.
• High-speed Internet and a distraction-free workspace required.
• Core hours: 8:00 AM - 6:00 PM ET, with potential for extended hours.
• Occasional travel (up to 10%) based on business needs.

This position is for pipeline purposes, and we welcome applications on an ongoing basis.

The pay range for this position is$65,000.00-$78,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full‑time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.