Utilization Management Registered Nurse

We’re seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our growing healthcare team.

In this role, you’ll perform both inpatient and outpatient utilization reviews while supporting transitions of care and ensuring patients receive appropriate, timely, and high-quality services.

The ideal candidate will bring strong clinical judgment , inpatient/SNF experience , and familiarity with MCG guidelines and Medicare Advantage regulations (LCD/NCD policies) .

This is a fully remote opportunity requiring discipline, accuracy, and effective collaboration across virtual teams.

Key Responsibilities:

• Conduct clinical reviews of inpatient, outpatient, and SNF services to assess medical necessity, appropriateness, and efficiency using evidence-based criteria (e.g., MCG).


• Evaluate and process prior authorization (PA) requests in a timely, compliant manner.
• Colla...