Registered Nurse - Utilization Review

This is a remote part-time registered nurse position with Saint Joseph Health System. The role involves conducting clinical reviews of patient records, collaborating with interdisciplinary teams, and supporting utilization review program operations.

Requirements

• Graduate of an accredited Registered Nurse (RN) program; Bachelor’s Degree in Nursing preferred
• Active RN license (state-specific requirement applies)
• Minimum of 2 years of acute care nursing experience
• Prior utilization review, case management, or payer review experience preferred
• Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines
• Solid understanding of clinical care practices, diagnoses, treatment modalities, and hospital operations
• Excellent communication skills with the ability to collaborate effectively across teams
• Strong analytical and critical thinking skills to assess clinical appropriateness and compliance
• Proficiency in computer systems and Microsoft Office applications
• Ability to manage multiple priorities in a fast-paced healthcare environment

Benefits

• Tuition reimbursement for all full-time and part-time colleagues starting on day one
• Comprehensive benefits beginning day one (Medical, Dental, Vision, PTO, Life Insurance, STD/LTD, and more)
• Retirement savings plan with employer match
• Generous paid time off program plus 7 paid holidays
• No mandatory overtime
• Employee referral incentive program
• Access to state-of-the-art equipment, unlimited CEUs, and a supportive team-focused work environment