Access & Authorization
Utilization Review Nurse (RN)
Remote (U.S.) Full-time Posted May 28, 2026
Apply InterQual and MCG criteria to concurrent inpatient review as part of an embedded utilization management team.
Responsibilities
- Conduct concurrent review of inpatient admissions against InterQual/MCG criteria
- Communicate status and continued-stay determinations proactively to payers
- Partner with case management on discharge planning coordination
- Document findings in a manner defensible under payer and regulatory review
Qualifications
- Active RN license required
- 2+ years utilization review or case management experience
- InterQual and/or MCG certification preferred
- Comfort with high-volume, concurrent review caseloads
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