Remote UTILIZATION REVIEW NURSE - RN

Role Overview

Nexus Health Systems is seeking an experienced Utilization Review Registered Nurse (UR RN) for a fully remote position to ensure medically necessary care and regulatory compliance.

What You'll Do

• Conduct concurrent and retrospective utilization reviews for medical necessity and level of care.
• Apply evidence-based criteria like InterQual to support clinical decisions.
• Collaborate with physicians and interdisciplinary teams for authorizations and discharge planning.
• Review clinical documentation for payer and regulatory compliance.
• Manage insurance authorizations, denials, appeals, and level-of-care determinations.
• Maintain accurate documentation within EHR systems while ensuring HIPAA compliance.

Qualifications

• Associate Degree in Nursing (ADN) required; Bachelor of Science in Nursing (BSN) preferred.
• Current, unrestricted Texas RN license or Compact RN license.
• Minimum of 2 years of acute care clinical nursing experience.
• At least 3 years of Utilization Review or Case Management experience.
• Proficiency with electronic health records (EHRs) and Microsoft Office.

Benefits

• Competitive compensation and comprehensive benefits.
• Paid time off and 401(k) with company match.
• Professional development and continuing education opportunities.