We are redirecting you to the source. If you are not redirected in 3 seconds, please click here.

Utilization Management Registered Nurse at Appworkshub. Location Information: USA. 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.. Collaborate with inpatient providers and case managers to support . Transitions of Care (TOC). and discharge planning.. Communicate clearly with interdisciplinary teams to ensure coordinated and effective care delivery.. Maintain . accurate, comprehensive documentation. in systems such as AcuityNxt and other electronic platforms.. Ensure compliance with . Medicare Advantage. , state, and federal healthcare regulations.. Contribute to . process improvement initiatives. to enhance overall UM effectiveness and efficiency.. What You’ll Bring:. Active, unrestricted RN license. (state-specific or compact).. 3+ years. of Utilization Management or related clinical review experience.. Proven experience with . Skilled Nursing Facility (SNF). utilization reviews.. Strong familiarity with . MCG criteria. , . LCD/NCD policies. , and . Medicare Advantage. rules.. Prior experience in . prior authorization (PA). and . Transitions of Care (TOC). workflows.. Excellent clinical communication skills and confidence in engaging with inpatient providers.. Strong attention to detail, documentation accuracy, and compliance focus.. Tech-savvy with the ability to quickly adapt to healthcare systems and remote work tools.. Why Join Us:. 100% Remote role – enjoy work-life balance while supporting patients across the continuum of care.. Collaborative, mission-driven healthcare environment.. Opportunity to expand into Transitions of Care (TOC) initiatives and process optimization.. Competitive compensation and benefits package.