REMOTE- OUTPATIENT UTILIZATION REVIEW RN- MUST BE NYS LICENSED
NOW HIRING: FULLY REMOTE RN – UTILIZATION REVIEW & APPEALS
100% FULLY REMOTE
Pay: $50–$55/hour
Monday–Friday | 9:00 AM–5:00 PM
Full-Time | Long-Term Temporary Opportunity
Active New York State RN License REQUIRED
We are seeking an experienced Registered Nurse with a STRONG background in Outpatient Utilization Review to join a growing healthcare team!
⭐ This is an excellent opportunity for an RN with hands-on experience in outpatient utilization review, prior authorizations, medical necessity reviews, grievances, and appeals.
✅ WHAT WE’RE LOOKING FOR
Active New York State RN License – REQUIRED
⭐ Strong Outpatient Utilization Review experience – REQUIRED
Prior Authorization experience
Medical Necessity Review experience
⚖️ Grievance & Appeals experience preferred
Managed Care / Health Plan experience preferred
Medicare, Medicaid and/or Medicare Advantage experience is a plus
WHAT YOU’LL BE DOING
Review outpatient services for medical necessity
Review prior authorizations and supporting clinical documentation
Handle clinical grievances and appeals
Collaborate with providers, Medical Directors, Claims, and Medical Management teams
Ensure cases are accurately documented and completed within required regulatory timelines
Support efficient and compliant utilization management processes
IMPORTANT REQUIREMENT
Strong OUTPATIENT Utilization Review experience is required for this position.
Candidates whose Utilization Review experience is primarily inpatient-based may not meet the requirements for this role.
100% REMOTE – NO ON-SITE REQUIREMENT
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