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REMOTE Utilization RN - 235674

October 14, 2026

Here is a complete, polished, and professional job posting structured based on your provided information:Job Title: Utilization Review (UR) Nurse Specialist – RN (Remote)About the RoleWe are seeking a highly skilled, self-motivated, and critical-thinking Utilization Review (UR) Nurse Specialist to join our team. In this fully remote position, you will play a key role in resource management, care appropriateness, and revenue integrity. You will be responsible for evaluating medical necessity, managing level-of-care decisions, minimizing denial rates, and collaborating closely with physicians, interdisciplinary teams, and commercial carriers.If you are an experienced RN with acute care background (ICU, ED, OR), exceptional clinical judgment, and an interest in leveraging modern technology and AI to streamline workflows, we want to hear from you!Key ResponsibilitiesResource Utilization & Medical Necessity<ul><li>Evaluate Care Appropriateness: Conduct medical necessity and level-of-care reviews (admission, continued stay, observation) using approved clinical criteria onsite or remotely.</li><li>Optimize Resource Usage: Utilize proactive indicators (diagnoses, cost criteria, complications) to detect potential over- or under-utilization and address barriers to patient progress.</li><li>Manage Carrier Reviews: Submit required clinical documentation to commercial carriers and the Financial Clearance Center (FCC) within one business day of admission.</li><li>Coordinate Level-of-Care Decisions: Facilitate physician advisor referrals and second-level reviews; collaborate with providers and care managers to secure necessary clinical documentation and clarify status.</li><li>Ensure Age-Specific Care: Assess patient data across all age groups and lifespans using clinical criteria, situational analysis, and departmental guidelines to prioritize reviews.</li></ul>Revenue Integrity & Denial Management<ul><li>Manage Appeals & Peer-to-Peer (P2P): Coordinate the P2P review process alongside physicians, the FCC, and Revenue Cycle teams, maintaining comprehensive documentation for appeal tracking.</li><li>Prevent & Track Denials: Maintain thorough documentation to minimize denial rates, log status updates and overturned days, monitor readmissions, and report emerging denial trends.</li><li>Execute Revenue Workflows: Manage assigned ConnectCare and ADT work queues to ensure seamless billing operations and compliance with CMS and revenue cycle goals.</li><li>Resolve Billing Issues: Partner with Patient Access, Financial Counselors, the FCC, and the Business Office to resolve third-party payer billing concerns and communicate non-coverage determinations.</li></ul>Communication & Interdisciplinary Collaboration<ul><li>Maintain Multidisciplinary Rapport: Partner closely with physicians, in-house care managers, nursing staff, and leadership to align on patient management and outcomes.</li><li>Educate Stakeholders: Train hospital and medical staff on utilization review processes, regulatory updates, and payer requirements (e.g., MS-DRGs, POA).</li><li>Adhere to Communication Protocols: Maintain professional, timely responsiveness across email, phone, and messaging tools according to FCC service-level agreements and guidelines.</li><li>Maintain Professionalism: Exhibit a calm, constructive demeanor during stressful situations or conflict resolution.</li></ul>Team Engagement & Administrative Responsibilities<ul><li>Support Departmental Operations: Assist peers during high-volume periods, cover coverage gaps, and accurately log statistical data within established deadlines.</li><li>Drive Process Improvement: Actively contribute to departmental quality initiatives, committee meetings, task forces, and staff development programs.</li><li>Ensure Compliance: Maintain clinical competency, professional development, and strict adherence to hospital policies, HIPAA, confidentiality standards, and patient rights.</li><li>Flexibility: Perform additional job-related duties as assigned by leadership.</li></ul>Work Schedule & ShiftsThis position operates on a 4x10 schedule (four 10-hour shifts per week), giving you an extra day off every week.<ul><li>Weekend Rotation: Team members work every other weekend as part of the regular rotation.</li><li>Shift Options Available:</li><li>10:00 a.m. – 8:00 p.m.</li><li>12:00 p.m. – 10:00 p.m. (Primary focus)</li></ul>Compensation, Bonus & Shift Differential Perks<ul><li>Base Salary: Midpoint around $78,875/year (up to $90,000–$92,000/year for highly experienced UR candidates).</li><li>Annual Bonus: 5% Target Annual Incentive Plan (AIP) bonus.</li><li>Stackable Shift Differentials:</li><li>10% Weekend Differential: Applied to all weekend hours worked.</li><li>10% Evening Differential: Applied to shifts worked between 12:00 p.m. and 10:00 p.m.</li><li>20% Stacked Premium: Combine evening and weekend shifts to earn a total 20% differential on top of your base pay!</li></ul>Qualifications & RequirementsRequired Skills & Qualifications<ul><li>Licensure: Current unrestricted Registered Nurse (RN) license required (RN Compact license preferred).</li><li>Clinical Experience: Hands-on clinical nursing experience in ICU, Emergency Department (ED), or Operating Room (OR).</li><li>Quality Improvement: Working knowledge of healthcare quality improvement processes.</li><li>Remote Setup: High-speed internet access suitable for remote work.</li><li>Clinical & Operational Judgment: Strong clinical assessment, critical thinking, and problem-solving skills with a proven ability to drive optimal patient, quality, and financial outcomes.</li><li>Communication & Negotiation: Exceptional written and verbal communication skills with a track record of negotiating effectively across physicians, payers, and multidisciplinary healthcare teams.</li><li>Customer Service Focus: Unwavering commitment to delivering exceptional customer service.</li><li>Time Management & Prioritization: Ability to organize complex information, prioritize competing tasks, and execute effectively in a fast-paced environment.</li><li>Autonomy & Initiative: Highly resourceful, self-motivated, and able to work independently.</li><li>Innovation & AI Mindset: Inquisitive and open to leveraging modern technologies, including AI, to streamline workflows and eliminate operational friction.</li><li>Remote & Travel Readiness: Remote position; candidates must be willing and able to travel and work on-site at corporate, client, or temporary locations as business needs dictate.</li></ul>Preferred Skills & Experience<ul><li>5+ years of dedicated Utilization Review (UR) Nurse experience.</li><li>Pediatric nursing experience.</li><li>Hands-on experience with the InterQual system.</li></ul>

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...