Remote Utilization Review RN (Hospital-Based Experience Required)

Quick Job Details:

Setting: Fully Remote – Utilization Review
Schedule: Full-Time, Monday–Friday
Hours: Standard Business Hours

Job Requirements:

• Active RN license with Multi-State/Compact License required
• Minimum 2 years of Utilization Review experience within a hospital or health system (provider-side required)
• Payer/insurance-only Utilization Management experience is not eligible
• Minimum 3 years of acute care/hospital RN experience
• Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement
• Experience applying InterQual and/or MCG criteria preferred
• Excellent communication, analytical, and critical thinking skills
• Ability to work independently in a remote environment

Responsibilities:

• Conduct admission, concurrent/continued stay, and observation reviews
• Apply medical necessity criteria to determine appropriate level of care
• Escalate cases to Physician Advisors when appropriate
• Collaborate with physicians, case managers, and insurance payers
• Support denial prevention, documentation improvement, and revenue cycle initiatives
• Ensure compliance with payer guidelines, CMS, and regulatory requirements
• Analyze clinical and financial data to identify quality improvement opportunities

Compensation: Competitive; based on experience

Benefits: Comprehensive benefits package

About Us

HealthPlus Staffing is a national leader in healthcare staffing. We partner with leading healthcare organizations nationwide to connect highly qualified professionals with exceptional career opportunities.

Our Promise

• Direct access to hiring decision-makers
• Timely feedback throughout the interview process
• Dedicated support to help you make an informed career decision

If you're interested in this opportunity, please submit your application or call 561-291-7787 to speak with one of our experienced recruiters. We look forward to helping you find your next opportunity!

The HealthPlus Team