Utilization Review Nurse – RN or LVN (Remote, $43/hr, Temp-to-Hire)
Join one of the nation’s leading managed care organizations, committed to transforming health care for underserved communities. Our client is a mission-driven health plan known for delivering accessible, high-quality care to millions of members. With a reputation for innovation and collaboration, they’re looking for compassionate, skilled clinicians to help ensure members receive the right care at the right time — every time.
We are seeking experienced Registered Nurses (RNs) or Licensed Vocational/Practical Nurses (LVNs/LPNs) with prior authorization and/or behavioral health utilization management experience to join a dedicated Utilization Management (UM) team. This is a fully remote, full-time, temporary-to-permanent opportunity starting in July 2025.
Position Details
Pay Rate: $43.00 per hour
Schedule: Monday to Friday, 8:00 AM – 5:00 PM (1-hour lunch)
Work Location: 100% remote
Licensure: Must hold an active, unrestricted RN or LVN license in Texas or a compact state
Position Summary
The Utilization Review Nurse is responsible for inpatient and outpatient medical necessity review, prior authorizations, and other UM activities. The goal is to ensure members receive appropriate, cost-effective, and timely care while supporting compliance with regulatory standards and promoting positive health outcomes.
Key Responsibilities
Perform concurrent review and prior authorization assessments per company policy
Evaluate member eligibility, benefits, and appropriate level of care
Participate in interdepartmental collaboration (Behavioral Health, Long-Term Care, etc.)
Document and maintain productivity and quality standards
Assist in onboarding and mentoring new team members
Consult regularly with medical directors and escalate as needed
Represent the organization professionally with internal and external stakeholders
Adhere to HIPAA, safety, and ethical standards in daily operations
Required Qualifications
Education: Completion of an accredited Registered Nursing or Vocational Nursing program (comparable experience/education combinations may be considered)
Experience:
Minimum 2 years UM or case management in a managed care organization
Experience with prior authorizations and/or behavioral health outpatient services
Licensure: Active, unrestricted RN or LVN license in Texas or a compact state
Technical Skills:
Familiarity with InterQual criteria and UM software
Microsoft Office proficiency (Word, Excel, Outlook)
Additional Skills:
Strong communication, organization, and multitasking
Knowledge of NCQA and regulatory standards
Ability to work independently and meet deadlines in a fast-paced environment
...purpose-led and values-driven leader at every level. To help us achieve this we have the PwC... ...of the Bar or other tax, technology, or finance-specific credentials may qualify for this... ...does not intend to hire experienced or entry level job seekers who will need, now or...
...Location: Bronx, NY 10451 Date Posted: 05/30/2025 Category: Case Management Education: Masters Degree With over 35 years in business, the Delta-T Group has built a reputation for referring highly qualified professionals for rewarding short and long-term independent...
...self- inspection of your work product. Maintain Doosan and Hyster fork trucks, including preventative maintenance. Maintain air compressors, including preventative maintenance. Repair and maintain paint pumps, rivet guns and shop equipment. Work collaboratively...
...just the thing for you. We take pride in our team members and our team members take pride in Domino's Pizza! Being the best pizza delivery company in the world requires exceptional team members working together. At Domino's Pizza, our people come first! Our mission is...
...you to work on both local and national projects. A role with construction documentation... ...industry standards, and relevant code Coordinate technical aspects of the project with internal... ...the weekend The ability to work remote up to 2 days a week once acclimated! Flexible...