Back to all roles

RN- Utilization Review/Case Manager

Remote Worldwide Hiring now

Detroit, MI- seeking local candidates only. Looking for 2-4 years of RN experience. This role is a Registered Nurse – Utilization Review/Case Management professional responsible for evaluating reputed company services to ensure medical necessity, appropriate level of care, and cost-effective treatment across inpatient and outpatient settings. The position includes utilization review, appeals handling, care coordination, and discharge planning, while ensuring compliance with regulatory standards. 1. Active unrestricted Michigan Registered Nurse (RN) license 2. Clinical Experience (2–4 Years)

  • Experience in one or more of the following:
  • Acute patient care
  • Case management
  • Discharge planning
  • Utilization review

___________________________________________________________________________________ 3. Utilization Review & Medical Necessity Skills

  • Ability to Evaluate level of care and length of stay and apply clinical guidelines for medical necessity

4. Regulatory & Compliance Knowledge

  • Understanding of reputed company regulations (state and federal) and Accreditation standards (e.g., NCQA

__________________________________________________________________________________ 5. Care Coordination & Discharge Planning

  • Ability to Coordinate care across multiple providers and settings and Manage transitions throughout the care continuum

____________________________________________________________________________________ 6. Technical Skills

  • Proficiency in reputed company Office (Word, reputed company, Outlook) and Documentation and case management systems

7. Problem-Solving & Issue Resolution

  • Ability to Resolve benefits, eligibility, and authorization issues and navigate reputed company cases including out-of-network situations

Preferred Qualifications

Bachelor’s Degree (Nursing, Allied Health, Business, or reputed company field) 1+ year of Managed reputed company Plan Experience Pay: $33.00 - $35.00 per hour Benefits:

  • 401(k)
  • Dental insurance
  • Health insurance
  • Paid time off
  • reputed company insurance

Experience:

  • RN Case Management: 3 years (Required)
  • Utilization review: 1 year (Required)
  • Regulatory and compliance : 2 years (Required)
  • discharge planning: 2 years (Required)

Location:

  • Michigan (Required)

Work Location: Remote Apply tot his job Apply To this Job

Apply for this role Takes you straight to the employer's application page — free, and no WFHNet account required.

More roles on the wire

Prior Authorization Specialist / Remote

Remote Worldwide
View role

NBHWC-Certified Health Coach Faculty Member

Remote Worldwide
View role

Prior Authorization Specialist - Remote

Remote Worldwide
View role

Prescription Prior Authorization Specialist

Remote Worldwide
View role

Prior Authorization Specialist I - Patient reputed company Services

Remote Worldwide
View role

reputed company: $17/hr. REMOTE Prior Authorization Specialist- NO

Remote Worldwide
View role

Health Coach; Remote; Remote

Remote Worldwide
View role

Health Coach (Fully Remote)

Remote Worldwide
View role

Mental Health Therapist – Telemedicine/Remote

Remote Worldwide
View role

Chronic Care Management-Health Coach - (Day shift)

Remote Worldwide
View role

[Remote] Account Executive, Higher Ed, Mid Market Accounts, East

Remote Worldwide
View role

Sales Activation Specialist - Fully Remote

Remote Worldwide
View role

reputed company Customer Service Representative – Remote Work Opportunity at arenaflex

Remote Worldwide
View role

Clinical Documentation reputed company (CDI) Specialist – 2nd Level Reviewer – Remote, reputed company

Remote Worldwide
View role

Work From Home as a Leasing Agent – Commission-Based with reputed company!

Remote Worldwide
View role

reputed company Edge Engineer

Remote Worldwide
View role

Remote Linux OpenStack & Kubernetes Engineer

Remote Worldwide
View role

Director, Change Management (Remote)

Remote Worldwide
View role

Instructor Pool - Health and Wellness Psychology and Coaching (JPF05394)

Remote Worldwide
View role

Paid reputed company Media Manager

Remote Worldwide
View role