Utilization Review Nurse â RN or LVN - Full Remote
Utilization Review Nurse â RN or LVN - Full Remote
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Job Description
Utilization Review Nurse RN or LVN (Remote $43/hr Temp-to-Hire)
Join one of the nations leading managed care organizations committed to transforming health care for underserved communities. Our client is a mission-driven health plan known for delivering accessible high-quality care to millions of members. With a reputation for innovation and collaboration theyre looking for compassionate skilled clinicians to help ensure members receive the right care at the right time every time.
We are seeking experienced Registered Nurses (RNs) or Licensed Vocational/Practical Nurses (LVNs/LPNs) with prior authorization and/or behavioral health utilization management experience to join a dedicated Utilization Management (UM) team. This is a fully remote full-time temporary-to-permanent opportunity starting in July 2025.
Position Details
Pay Rate: $43.00 per hour
Schedule: Monday to Friday 8:00 AM 5:00 PM (1-hour lunch)
Work Location: 100% remote
Licensure: Must hold an active unrestricted RN or LVN license in Texas or a compact state
Position Summary
The Utilization Review Nurse is responsible for inpatient and outpatient medical necessity review prior authorizations and other UM activities. The goal is to ensure members receive appropriate cost-effective and timely care while supporting compliance with regulatory standards and promoting positive health outcomes.
Key Responsibilities
Perform concurrent review and prior authorization assessments per company policy
Evaluate member eligibility benefits and appropriate level of care
Participate in interdepartmental collaboration (Behavioral Health Long-Term Care etc.)
Document and maintain productivity and quality standards
Assist in onboarding and mentoring new team members
Consult regularly with medical directors and escalate as needed
Represent the organization professionally with internal and external stakeholders
Adhere to HIPAA safety and ethical standards in daily operations
Required Qualifications
Education: Completion of an accredited Registered Nursing or Vocational Nursing program (comparable experience/education combinations may be considered)
Experience:
Minimum 2 years UM or case management in a managed care organization
Experience with prior authorizations and/or behavioral health outpatient services
Licensure: Active unrestricted RN or LVN license in Texas or a compact state
Technical Skills:
Familiarity with InterQual criteria and UM software
Microsoft Office proficiency (Word Excel Outlook)
Additional Skills:
Strong communication organization and multitasking
Knowledge of NCQA and regulatory standards
Ability to work independently and meet deadlines in a fast-paced environment
Employment Type
Hourly
