Utilization Management RN – Remote

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