Utilization Review Nurse - RN | 100% Remote | Part-Time| AT

NRI, Inc.; Washington (District of Columbia); Remote; USD 30,000 - 50,000; Part time

Benefits offered by this job

100% remote

Part-time schedule

Evenings & Weekends

Job summary

NRI, Inc. is seeking an experienced Registered Nurse (RN) for Utilization Review to support long-term care patients and facilities from a remote role. This 100% remote position emphasizes efficient reviews, regulatory compliance, and collaboration with care teams across locations.

The role offers 10-20 hours per week with flexibility for evenings and weekends, making it ideal for RNs seeking supplemental or flexible work while staying clinically engaged.

Qualifications

• Experience with Utilization Review or Utilization Management.
• Long-term care experience.
• Admissions screening and care planning experience.
• Familiarity with MDS and Medicare/Medicaid criteria.
• Experience with continued stay reviews and quality improvement.

Responsibilities

• Conduct utilization management and quality reviews to evaluate medical necessity, patient acuity, and continued need for services.
• Review clinical documentation, care plans, and patient records for compliance with Medicare, Medicaid, PASRR, MDS, and other regulatory requirements.
• Evaluate appropriate levels of care and identify potential gaps or concerns.
• Collaborate virtually with providers, care teams, and other healthcare professionals.
• Support quality improvement, regulatory compliance, and appropriate utilization of services.
• Complete accurate and timely clinical reviews and documentation.
• Manage multiple cases while meeting established deadlines.

Skills

Utilization Review

Long-term care

Admissions screening

MDS

Medicare/Medicaid criteria

Continued stay reviews

Quality improvement

Clinical documentation review

Jiva

Tools

Jiva

Job description

Utilization Review Nurse - RN | 100% Remote | Part-Time

10-20 Hours Per Week | Flexible Schedule | Evenings & Weekends

Looking for a way to use your nursing experience without returning to a full-time bedside schedule?

We're seeking an experienced Registered Nurse (RN) with Utilization Review/long-term care experience to join a healthcare team supporting patients and long-term care facilities in the Washington, DC and Maryland area.

This is a 100% remote, part-time position offering approximately 10-20 hours per week, with flexibility to work evenings and weekends. It's an excellent opportunity for an experienced nurse looking for a flexible schedule, supplemental work, or a way to stay clinically engaged outside of a traditional full-time role.

Why This Role Stands Out

• 100% work from home - no office or facility visits required.
• Part-time: 10-20 hours per week.
• Flexible scheduling with evening and weekend availability.
• Use your clinical knowledge and nursing experience in a less traditional role.
• Review cases and documentation while helping support appropriate patient care and level-of-care decisions.
• Great opportunity for experienced RNs seeking work-life flexibility or supplemental hours.

What You'll Be Doing

• Conduct utilization management and quality reviews to evaluate medical necessity, patient acuity, and continued need for services.
• Review clinical documentation, care plans, and patient records for compliance with Medicare, Medicaid, PASRR, MDS, and other regulatory requirements.
• Evaluate appropriate levels of care and identify potential gaps or concerns.
• Collaborate virtually with providers, care teams, and other healthcare professionals.
• Support quality improvement, regulatory compliance, and appropriate utilization of services.
• Complete accurate and timely clinical reviews and documentation.
• Manage multiple cases while meeting established deadlines.

What We're Looking For

The ideal candidate has experience with:

• Utilization Review or Utilization Management
• Long-term care
• Admissions screening and care planning
• MDS
• Medicare and Medicaid criteria
• Continued stay reviews
• Quality improvement
• Clinical documentation review

Experience with Jiva or a similar medical management platform is a plus.