Utilization Review Nurse – RN or LVN - Remote

Overview

The Utilization Review Nurse is responsible for inpatient and outpatient medical necessity review, prior authorizations, and other UM activities, ensuring members receive appropriate, cost-effective, and timely care while supporting compliance with regulatory standards.

In Short

• Position: Utilization Review Nurse – RN or LVN
• Work Location: 100% remote
• Pay Rate: $43.00 per hour
• Schedule: Monday to Friday, 8:00 AM – 5:00 PM
• Requires active RN or LVN license in Texas or a compact state
• Minimum 2 years UM or case management experience
• Experience with prior authorizations and behavioral health services
• Familiarity with InterQual criteria and UM software
• Strong communication and organizational skills required
• Opportunity is temporary-to-permanent starting in July 2025

Requirements

• Completion of an accredited Registered Nursing or Vocational Nursing program
• Minimum 2 years of experience in a managed care organization
• Active, unrestricted RN or LVN license in Texas or a compact state
• Familiarity with InterQual criteria and UM software
• Proficiency in Microsoft Office (Word, Excel, Outlook)
• Strong communication, organization, and multitasking skills
• Knowledge of NCQA and regulatory standards
• Ability to work independently and meet deadlines

Benefits

• Work from home flexibility
• Opportunity to make a difference in underserved communities
• Collaborative work environment
• Potential for permanent employment