Remote Utilization Review RN

Location: 100% REMOTE
Contract Duration: 12+ month [Possible Extension]
License Requirements: MI RN License

1. Mandatory Requirements to Apply

• Nursing Diploma or Associate Degree required; BSN preferred.

• 5+ years in healthcare/health-related fields.

• 3–5 years of Care Management and/or Utilization Management experience.

• Strong hands-on knowledge of InterQual criteria and utilization management.

• Experience with clinical reviews, staff training, quality management, and/or audits.

• Knowledge of ICD-10, CPT, CMS, NCQA, PA 60, and HIPAA.

• Strong communication, analytical, training, and project management skills.

• Proficiency with Microsoft Office, Teams, SharePoint, and healthcare systems.

2. Roles & Responsibilities

• Train and educate staff and provider facilities on InterQual criteria, clinical policies, utilization management, and departmental processes.

• Conduct clinical quality reviews and audits to support quality and regulatory requirements.

• Develop and update InterQual-focused training materials, manuals, and educational programs.

• Mentor new employees and work with leadership and subject matter experts to identify training needs.

• Support new systems, process improvements, accreditation activities, and quality initiatives.

3. Pay & Benefits

• $35–$39/hour

• 100% remote – Michigan residents only

• 9 days of Paid Time Off

• Health Insurance (Dental, Medical and Vision)

• All equipment provided by the client

Pay: $35.00 - $39.00 per hour

Benefits:

• Dental insurance

• Health insurance

• Paid time off

• Vision insurance

Experience:

• Registered Nurse: 6 years (Required)

• Utilization Review: 4 years (Required)

• InterQual: 3 years (Required)

License/Certification:

• MI Registered Nurse License (Required)

Location:

• Michigan (Required)

Work Location: Remote

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