<p><strong>Utilization Management RN – Remote</strong></p><p><strong>Location:</strong> Fully Remote (Must reside in PA, NJ, or DE for permanent conversion)</p><p><strong>Position Type:</strong> Contract (6–12+ months) with potential for full-time conversion</p><p><br></p><p><strong>As a Utilization Management Nurse, you will:</strong></p><ul><li>Review medical records to determine medical necessity for services</li><li>Apply clinical guidelines such as InterQual, Milliman, or MCG</li><li>Approve care based on established criteria</li><li>Refer cases not meeting criteria to the Medical Director</li><li>Communicate with providers to obtain or clarify clinical information</li><li>Work fully remote in an analytical, non-bedside role</li></ul><p><br></p><p><strong>Qualifications</strong></p><ul><li>Active RN license (required)</li><li>Associate’s or Bachelor’s degree in Nursing (BSN preferred)</li><li>3+ years hospital or clinical experience</li><li>Utilization Management, Prior Authorization, or Medical Management experience (hospital or insurance)</li><li>InterQual or similar criteria experience (Milliman, MCG)</li><li>Strong critical thinking and communication skills</li></ul><p><br></p><p><strong>What We Offer</strong></p><ul><li>Fully remote work with equipment provided</li><li>Contract-to-hire opportunity with strong conversion potential</li><li>Competitive hourly rate</li><li>Opportunity to work with a well-established health insurance organization</li></ul><p></p>
