Utilization Management Registered Nurse (RN)

Type: 6-Month Contract W2

Location: Remote - but MUST reside in one of the following states: IL, TX, NM, OK, MT, TN

Schedule: Monday–Friday, 8:00 AM–5:00 PM EST or CST. No nights or weekends required!

Compensation: $40/hour

Summary: We are seeking a Utilization Management RN to join our team on a remote, contract basis. This role is ideal for a nurse with recent experience in health plan operations and utilization review. You will be responsible for evaluating healthcare services, coordinating care, and ensuring members receive high-quality, cost-effective treatment.

Responsibilities

• Perform delegated tasks within the Nurse Case Management job family
• Collaborate with physicians to plan, implement, and evaluate healthcare services
• Use clinical expertise to assess, coordinate, and monitor care options for optimal outcomes
• Conduct utilization reviews (prospective, concurrent, retrospective) for inpatient, outpatient, and rehabilitation services
• Provide health education and clinical assessments to members
• Independently manage caseloads and coordinate assigned cases
• Resolve escalated issues and support junior team members
• Evaluate alternative care services to ensure program goals and cost-effective care
• Maintain compliance with clinical guidelines and regulatory standards
  
  

Qualifications

• Active, unrestricted RN license in the U.S.
• Minimum 2 years of Utilization Management RN experience, including Prior Authorization and Concurrent Review
• Experience working for a health plan (payer) within the last 3 years
• Proficiency with Milliman Care Guidelines (MCG) or InterQual Criteria
• Strong computer literacy and comfort with digital tools
  
  

Ready to make a meaningful impact—without sacrificing work-life balance? If you're a passionate RN with a sharp eye for clinical detail and a heart for patient advocacy, we’d love to hear from you. This is your chance to bring your expertise to a dynamic team, work remotely, and help shape better healthcare outcomes across the country.

Apply now and let’s do great work together!

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