Utilization Management RN

Job Summary

Seeking a full-time remote Utilization Management RN, the successful candidate will manage medical record reviews and denial documentation, develop clinical appeal letters, and utilize clinical judgment to support healthcare provider clients.

Key Responsibilities

• Perform detailed medical record reviews and analyze healthcare insurance denial documentation
• Prepare accurate and defensible clinical appeal letters based on clinical information and supporting documentation
• Collaborate with healthcare professionals to ensure compliance with policies and quality standards

Required Qualifications

• Current, active Registered Nurse (RN) license
• 3+ years of bedside nursing experience in Adult Emergency Department, Telemetry, ICU, or CCU
• Strong clinical assessment and critical-thinking skills
• Excellent written communication and professional writing skills
• Proficiency with Microsoft Word and standard computer applications