Utilization Review Nurse (Remote)

About the Role

The Utilization Review Nurse at Martin's Point Health Care is a remote position focused on reviewing inpatient and outpatient prior authorization requests to ensure high-quality, cost-efficient medical outcomes. This role involves medical necessity reviews, discharge planning, and coordination of care transitions.

Key Responsibilities

• Review prior authorization requests for medical necessity.
• Collaborate with medical directors and healthcare providers.
• Manage claims disputes and coordinate referrals to care management.
• Maintain documentation and compliance with regulatory standards.
• Participate in quality initiatives and process improvements.
• Provide weekend coverage on a rotating basis.

Requirements

• Associate's degree in nursing required; Bachelor's preferred.
• Compact RN license.
• Minimum 3 years clinical nursing experience, preferably hospital setting.
• At least 2 years utilization management experience.
• Certification in managed care nursing or care management preferred.
• Familiarity with coding (ICD-10, CPT) preferred.

Benefits & Compensation

• Not specified.

Work Schedule

• Weekend coverage required on a rotating basis.
• Other schedule details not specified.

This role is fully remote, allowing work from home or anywhere within the states Martin's Point operates. No salary or benefits details were provided. Call requirements are not explicitly stated. Weekend coverage is explicitly required on rotation. No night shift details were mentioned.

This position offers a chance to work in a mission-driven, innovative healthcare organization with a culture of trust and respect. If you want to contribute to transforming healthcare while working remotely, this role fits well.

Apply to join a team that values continuous learning, patient advocacy, and teamwork.