RN Utilization Review Medical Review

Registered Nurse (Utilization Review / Medical Review)

Pay:$41/hr.

Employment Type: Full-Time
Location: Remote local candidates
Candidate Location Preference: Austin and surrounding areas

Schedule and Work Hours

• Required availability: Between 7:00 AM and 7:00 PM
• Primary shift: 10:00 AM-7:00 PM
• Standard 8-hour shifts
• Overtime may be required only when approved
• No direct patient care

Role Overview

We are seeking a Registered Nurse with utilization review or medical review experience to support pre-service concurrent and retrospective reviews in a remote environment. This role focuses on ensuring medically appropriate high-quality and cost-effective care by applying clinical judgment regulatory guidelines and medical necessity criteria.

This position is ideal for an RN who is detail-oriented highly analytical and comfortable collaborating with healthcare providers in a non-clinical administrative setting.

Key Responsibilities

• Conduct pre-service concurrent and retrospective utilization reviews
• Assess medical necessity for outpatient services out-of-network services and appropriateness of treatment settings
• Collaborate with healthcare providers to promote quality member outcomes and optimize benefit utilization
• Ensure care decisions align with clinical guidelines regulatory standards and professional scope of practice
• Promote effective and efficient use of healthcare resources
• Apply Texas Administrative Code (TAC) rules as applicable
• Document review decisions clearly and accurately
• Support quality compliance and cost-containment objectives

Required Skills and Competencies

• Strong understanding of medical necessity criteria
• Working knowledge of Texas Administrative Code (TAC) regulations
• Proficiency with Microsoft Word and Excel
• Excellent clinical judgment analytical thinking and documentation skills
• Ability to work independently in a remote environment
• Strong communication skills for provider collaboration

Required Qualifications

• Active Registered Nurse (RN) license
• Experience conducting utilization review medical review or similar non-bedside nursing functions
• Ability to work assigned shifts between 7:00 AM and 7:00 PM with a primary 10:00 AM-7:00 PM schedule
• Local residency in or near Austin TX preferred

Position Highlights

• Fully remote role with no direct patient care
• Predictable scheduling with defined shift expectations
• Opportunity to apply clinical expertise in a regulatory and quality-focused environment
• Collaborative role supporting provider alignment and member outcomes

Search-Optimized Alternate Titles -Utilization Review Nurse RN Utilization Management Medical Review Nurse UM Nurse Case Review RN Remote Utilization Review RN Health Plan RN Clinical Review Nurse

Throughout the past 35 years MMC one of the most trusted names in workforce management services has successfully delivered strategic solutions to large and small businesses in numerous industries.

We have built our reputation on partnering with our clients and candidates to achieve the desired results. Our recruiting professionals have extensive experience matching the right candidate to the right client for the right position. We provide the best opportunities to the most talented candidates in a multitude of industries.

MMC is a privately owned business with corporate headquarters in Irving Texas. With 2000 employees working in 40 states MMC is able to support all United States locations and some international locations.

We appreciate your interest in reviewing this particular position and we encourage you to visit our website where you can always search and apply for opportunities at

Benefits with MMC Group
MMC offers health insurance plans for our active candidates on assignment including:

• Medical dental and vision coverage
• Life and disability insurance
• Additional voluntary benefits

Join MMC and enjoy the support of a team that values your well-being both on and off the job!

MMC strives to ensure all job posting confirm details of the position the rate of pay and acknowledge medical benefits are offered.

Get started on your career journey today! Apply to become a part of the MMC Team!

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability status protected veteran status or any other characteristic protected by compliance with federal law all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.