Remote Rn Utilization Review Nurse Jobs (NOW HIRING)

We are sharing a specialised part-time consulting opportunity for United States-based healthcare professionals experienced in utilization management, case management, medical necessity review, care coordination, discharge planning, clinical review criteria, physician advisor workflows, and healthcare operations leadership.

This role supports current and upcoming remote consulting opportunities focused on AI-assisted healthcare review, utilization management evaluation, case management workflow assessment, clinical documentation review, and high-quality project execution. Selected professionals will apply clinical and operational expertise to evaluate medical necessity determinations, review AI-generated utilization management outputs, assess care coordination workflows, and provide structured feedback based on detailed project criteria.

Professionals in this role may contribute to:

• Review utilization management and case management workflows involving concurrent review, retrospective review, discharge planning, care coordination, and level-of-care determinations
• Evaluate AI-generated medical necessity determinations, clinical review outputs, and decision-support recommendations for accuracy and clinical appropriateness
• Apply InterQual, MCG, Milliman, or similar clinical review criteria to support admission, continued stay, observation status, and inpatient determinations
• Assess clinical documentation, review logic, and care pathway recommendations against professional utilization management standards

• Review complex utilization management cases involving peer-to-peer review requests, denial appeals, payer communication, and physician advisor escalation
• Evaluate workflows related to care transitions, post-acute coordination, discharge planning, and collaboration between clinical teams, payers, and providers
• Assess operational indicators such as avoidable days, denial rates, observation versus inpatient conversion, readmission risk, and utilization performance
• Identify gaps, inconsistencies, edge cases, or unsupported conclusions in clinical review and case management outputs

• Annotate AI-generated healthcare outputs and provide structured feedback to support clinical review quality
• Explain review decisions with consistency, attention to detail, and professional clinical judgment
• Apply CMS Conditions of Participation, Two-Midnight Rule, payer-specific requirements, and utilization management best practices where relevant
• Collaborate through structured project workflows involving clinical, operational, compliance, and healthcare technology review

Strong candidates may have:

• 5+ years of experience in utilization management, case management, clinical review, or healthcare operations
• At least 2 years of leadership experience in utilization management, case management, physician advisor operations, or related clinical review functions
• Active clinical licensure, with a Registered Nurse license required for nursing leadership profiles
• Physician advisor, MD, or DO experience may be especially relevant for physician advisor-focused workflows
• Strong medical necessity review expertise and deep familiarity with clinical review criteria
• Exceptional written and verbal English communication skills
• High attention to detail and ability to critically evaluate clinical documentation, workflow logic, and AI-generated healthcare outputs
• Ability to work independently in a remote, project-based environment

Active Registered Nurse licensure is required for Registered Nurse utilization management or case management leadership profiles

• MD or DO background with physician advisor, utilization management, or clinical review experience may be preferred for physician advisor-focused roles
• Professional experience in health systems, hospitals, payer environments, accountable care organizations, value-based care organizations, or clinical operations teams is highly relevant
• Backgrounds in utilization management leadership, case management management, clinical documentation review, revenue cycle collaboration, denial management, or care coordination may support project fit

• CPUR, ACM, CCM, or similar utilization review, case management, or clinical operations credential
• Experience managing physician advisor programs, peer-to-peer review processes, denial appeals, or complex medical necessity cases
• Familiarity with utilization management platforms, clinical review software, EHR systems, or related healthcare operations tools
• Experience with CMS Two-Midnight Rule, observation status regulations, inpatient criteria, payer policies, and compliance requirements
• Exposure to healthcare technology, AI-assisted clinical tools, digital health workflows, or structured annotation and review processes
• Background in health system, accountable care, value-based care, or payer-facing utilization management programs

• Apply utilization management and case management leadership expertise to structured remote healthcare review work
• Contribute to high-quality AI-assisted clinical review and medical necessity evaluation workflows
• Use operational judgment, clinical review criteria, and care coordination experience in a focused evaluation environment
• Work on flexible assignments aligned with healthcare operations, utilization performance, case review, and clinical decision-support expertise
• Remote structure with competitive hourly compensation

• Independent contractor role
• Fully remote with flexible scheduling
• United States-based professionals are required for this opportunity
• Part-time project-based commitment depending on availability, onboarding status, and project needs
• Competitive rates of $80–$120 per hour depending on clinical background, leadership experience, utilization management expertise, and project scope
• Weekly payments via Stripe or Wise
• Projects may be extended, shortened, or adjusted depending on scope and performance
• Work will not involve access to confidential or proprietary information from any employer, client, or institution

This opportunity is available through 24-MAG LLC. We connect experienced professionals with remote consulting opportunities across technical, evaluation, and project-based workstreams.