Utilization Review RN
Jobgether - US
Still listed by Jobgether · checked today · posted 13 Oct 2026 (2 days ago)
Skills: Utilization review, Medical necessity, Clinical criteria, Payer requirements, Claims denial management, Quality improvement, Care coordination, Regulatory compliance, Revenue cycle
This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Utilization Review RN based in the United States.
Join a healthcare team dedicated to improving patient outcomes, ensuring appropriate resource utilization, and supporting the financial integrity of hospital operations. In this part-time, remote role, you will apply your clinical expertise to evaluate medical necessity, review patient admissions, and ensure care aligns with established clinical criteria and payer requirements. Working closely with physicians, care managers, insurance representatives, and revenue cycle professionals, you will help resolve utilization concerns and minimize claim denials. You will also contribute to quality improvement initiatives, regulatory compliance, and effective care coordination across a diverse patient population. The position offers flexible part-time scheduling options, with shifts distributed across a seven-day coverage schedule. It is an excellent opportunity for a registered nurse who combines strong clinical judgment with analytical skills and a commitment to high-quality, cost-effective healthcare.