Utilization Review Nurse - RN or LVN - Full Remote Job at Morgan Stephens, Remote

U3NWRWlZL010OGpqNXUyVTQwb2NvbXBXZlE9PQ==
  • Morgan Stephens
  • Remote

Job Description

Utilization Review Nurse – RN or LVN (Remote, $43/hr)

Join one of the nation’s leading managed care organizations, committed to transforming health care for underserved communities. Our client is a mission-driven health plan known for delivering accessible, high-quality care to millions of members. With a reputation for innovation and collaboration, they’re looking for compassionate, skilled clinicians to help ensure members receive the right care at the right time — every time.

We are seeking experienced Registered Nurses (RNs) or Licensed Vocational/Practical Nurses (LVNs/LPNs) with prior authorization and/or behavioral health utilization management experience to join a dedicated Utilization Management (UM) team. This is a fully remote, full-time opportunity starting in September 2025.

Position Details

  • Pay Rate: $43.00 per hour

  • Schedule: Monday to Friday, 8:00 AM – 5:00 PM (1-hour lunch)

  • Work Location: 100% remote

  • Licensure: Must hold an active, unrestricted RN or LVN license in Ohio or a compact state. Preference for Ohio residents and licenses.

Position Summary
The Utilization Review Nurse is responsible for inpatient and outpatient medical necessity review, prior authorizations, and other UM activities. The goal is to ensure members receive appropriate, cost-effective, and timely care while supporting compliance with regulatory standards and promoting positive health outcomes.

Key Responsibilities

  • Perform concurrent review and prior authorization assessments per company policy

  • Evaluate member eligibility, benefits, and appropriate level of care

  • Participate in interdepartmental collaboration (Behavioral Health, Long-Term Care, etc.)

  • Document and maintain productivity and quality standards

  • Assist in onboarding and mentoring new team members

  • Consult regularly with medical directors and escalate as needed

  • Represent the organization professionally with internal and external stakeholders

  • Adhere to HIPAA, safety, and ethical standards in daily operations

Required Qualifications

  • Education: Completion of an accredited Registered Nursing or Vocational Nursing program (comparable experience/education combinations may be considered)

  • Experience:

    • Minimum 2 years UM or case management in a managed care organization

    • Experience with prior authorizations and/or behavioral health outpatient services

  • Licensure: Active, unrestricted RN or LVN license in Ohio or a compact state. Preference to Ohio residents and licenses.

  • Technical Skills:

    • Familiarity with InterQual criteria and UM software

    • Microsoft Office proficiency (Word, Excel, Outlook)

  • Additional Skills:

    • Strong communication, organization, and multitasking

    • Knowledge of NCQA and regulatory standards

    • Ability to work independently and meet deadlines in a fast-paced environment

 

Job Tags

Hourly pay, Full time, Work at office, Monday to Friday,

Similar Jobs

Check-Mate Industries

1st shift: Part-time Worker- (Shifts: 10-2 M-F or 7-3:30 T,W,TH)- 15.00 hourly Job at Check-Mate Industries

 ...Part-time Assembly, Resize, Fabrication and Finishing As a part-time worker, you will...  ...Candidates can choose the following shifts: ~20 hours per week ~ Monday through Friday (10:00...  ...(7:00 a.m. 3:30 p.m.) Pay: ~$15.00/hour (paid weekly) EOE/AA/M/F/ET/D... 

Jackson Health System

Human Resources Director Job at Jackson Health System

 ...Job Description Department: Jackson Memorial Hospital-Human Resources Address: 1611 NW 12thAve, Miami, Florida, 33136 Shift details: Full-Time, Days Ready to elevate Your HR Leadership in Healthcare? Jackson Health System is looking for a dynamic HR leader... 

Pinnacle Live

Rigging Services Supervisor Live Events & AV Job at Pinnacle Live

 ...A leading AV solutions provider in Miami Beach seeks a Rigging Services Supervisor responsible for overseeing the safe installation and operation of rigging elements at events. The role involves supervising a team, conducting safety inspections, and acting as the main... 

New York Family Dentistry

Dental Receptionist Job at New York Family Dentistry

 ...efficiency and patient satisfaction using Dentrix Ascend, Open Dental or similar software. Lead front office operations ,...  ...patient flow and high-quality care. Train and mentor junior receptionists and administrative staff , fostering a culture of... 

Knott's Berry Farm

Safety Manager Job at Knott's Berry Farm

Overview: Responsible for the management of all Safety Division operations to provide for a safe and secure environment for all associates...  ...-8 years of relevant work experience. Extensive knowledge of OSHA standards, NFPA codes and Amusement Park ASTM standards....