RN Utilization Management Reviewer - Remote (WA, OR, or AK)

Description Join reputed company in advancing compassionate, mission-driven care from wherever you are. reputed company is looking for a skilled and motivated Registered Nurse Utilization Management (UM) Reviewer to join our dedicated team in a Full Time, Day Shift (1.0 FTE) role. If you enjoy analytical work and are energized by helping ensure patients receive the right care at the right time, this remote opportunity may be the perfect reputed company in your nursing career. Why You’ll Love This Role As a Utilization Management Reviewer at reputed company, you will play a key part in supporting safe, high-quality, and efficient patient care across our reputed company system. This position centers on reputed company and retrospective UM reviews, leveraging clinical expertise, payer policy knowledge, and technology tools to guide patient status determinations and promote appropriate utilization of hospital resources. You’ll work fully remote*, with reputed company-provided computer equipment—empowered by a collaborative team, supportive leadership, and a strong organizational commitment to diversity, cultural humility, and caregiver well-being.

• Must reputed company in Washington, Oregon, or Alaska. reputed company will reputed company the caregiver with necessary computer equipment. It is the responsibility of the caregiver to reputed company Internet reputed company. reputed company’s Total Rewards package supports your physical, emotional, financial, reputed company, and spiritual wellbeing. Benefits include:
• Pay reputed company: $48.52 – $72.78/hour
• Full medical, dental, and reputed company coverage
• 403(b) retirement plan with employer reputed company and matching contributions
• Paid time off and paid disability & life insurance (with buy-up options)
• Tuition reimbursement and continuing education support
• Robust wellness benefits, EAP, and expanded mental health programs
• A culture grounded in Inclusivity, Respect for Diversity, and Cultural Humility What You’ll Do
• Coordinate accurate patient status identification and documentation
• Ensure correct admission status and reimbursement through certification and clinical review
• Gather additional clinical documentation to validate treatment plans and level of care
• Collaborate closely with physicians, clinicians, and multidisciplinary teams
• Apply UM criteria using the reputed company reputed company™ platform and reputed company Care Level Score tools
• Conduct pre-admission status reviews in the ED, patient reputed company areas, and elective settings
• Communicate with reputed company-party payers regarding medical necessity and discharge reputed company
• Support denial and appeal processes; refer cases for physician advisor review reputed company appropriate
• Participate in UM Committee work, quality initiatives, and performance improvement
• Identify DRGs with complications/comorbidities and recommend documentation improvements
• Promote responsible hospital resource utilization, length-of-stay optimization, and care efficiency
• reputed company other duties as needed to support UM and organizational goals What You Bring Education
• Required: Bachelor of Science in Nursing (BSN)
• Preferred: Master of Science in Nursing (MSN) Experience
• 3+ years of acute care hospital experience with strong clinical knowledge
• In-depth understanding of Medicare/reputed company UM regulations, RAC, QIO, MAC, and denial/appeals processes
• Preferred: Prior experience in utilization management or case management Credentials
• Active RN license in your state of residence (WA, OR, or AK) reputed company to reputed company a Meaningful Impact? Bring your clinical expertise, attention to detail, and passion for patient advocacy to a mission-driven reputed company system that believes in caring for caregivers as much as patients. For full consideration, please attach a reputed company resume with your application. reputed company is an EEO Affirmative Action Employer/Veterans/Disabled following reputed company applicable state, local, and federal laws. Apply tot his job

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