Registered Nurse – Utilization Review

This is a fully remote position, open to applicants in South Carolina.

📋 Description

• Oversee clinical care and resource utilization by assessing medical necessity, appropriateness of care, ongoing stay, and discharge planning.

• Complete and submit admission and concurrent reviews to insurance providers.

• Obtain authorizations and identify/document avoidable days.

• Communicate and document clinical details to payers concerning admissions, levels of care, lengths of stay, and authorization criteria.

• Advocate with payers to secure appropriate reimbursement, prevent denials, and manage dispute resolution, including secondary reviews and peer-to-peer appeals.

• Educate and support physicians and healthcare teams on care progression, suitable levels of care, safe patient transitions, and available resources and benefits.

• Ensure adherence to federal, state, and local regulations as well as accreditation standards.

⛳️ Requirements

• Associate's degree in Nursing required.

• Minimum of two years of experience in acute hospital or Behavioral Health patient care.

• Active Registered Nurse license is mandatory.

• Bachelor of Science in Nursing (BSN) is preferred.

• Accredited Case Manager (ACM) certification is preferred.

🏝️ Benefits

• Medical, dental, vision, and life insurance.

• 401(k) retirement savings plan with employer matching contributions.

• Generous paid time off.

• Opportunities for career development and continuing education.

• Health savings accounts.

• Flexible spending accounts for healthcare and dependents.

• Pet insurance.

• Legal insurance.

• Accident and critical illness insurance.

• Long-term care insurance.

• Benefits for elder and childcare.

• Auto and home insurance options.

• Up to $20,000 sign-on bonus based on eligibility.