Utilization Review RN (Remote)

Quick Job Details:

Setting: Fully Remote – Utilization Review
Schedule: Full-Time, Monday–Friday
Hours: Standard business hours
Patient Volume: N/A
Job Requirements:

• Active RN license with Multi-State/Compact license required
• Minimum 2 years of Utilization Review experience
• Minimum 3 years of clinical nursing experience (acute care/hospital preferred)
• Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement
• Excellent communication, analytical, and critical thinking skills
• Ability to work independently in a remote environment

Responsibilities:

• Conduct admission, continued stay, and observation reviews
• Apply medical necessity criteria to determine appropriate level of care
• Review cases for Physician Advisor escalation when appropriate
• Collaborate with physicians, case managers, and insurance payers
• Support denial prevention, documentation improvement, and revenue cycle initiatives
• Ensure compliance with payer guidelines 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 the healthcare staffing industry. We partner with top healthcare organizations nationwide to connect highly qualified professionals with outstanding career opportunities.

Our Promise:

• We will put you in front of the decision makers.
• We will provide feedback on your application.
• We will work on your behalf to obtain as much information as possible to help you make a well-informed decision.

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

The HealthPlus Team