Inpatient Utilization Review RN

Remote Inpatient Utilization Review RN

Location: Remote (U.S.)

Contract Length: 3 months

Pay Rate: $34/hr

Equipment Provided

Our client is actively seeking a skilled and compassionate Registered Nurse (RN) to join their team as a Remote Inpatient Utilization Review RN. This role is ideal for experienced RNs who thrive in clinical evaluation, care coordination, and utilization management within an inpatient setting.

Role Overview

The RN will perform initial and continued stay reviews for inpatient admissions using established clinical guidelines (MCG or Medical Policy Criteria). The goal is to ensure appropriate level of care, optimize resource use, and support seamless transitions across the continuum of care.

Key Responsibilities

• Assess clinical needs against established guidelines to determine medical necessity and appropriate length of stay.
• Conduct initial and concurrent inpatient reviews using MCG or Medical Policy Criteria.
• Evaluate the efficiency and appropriateness of medical services and procedures.
• Coordinate care across providers, facilities, and external partners to ensure quality and cost-effective outcomes.
• Monitor medical care activities and outcomes across all service sites.
• Document findings and decisions accurately in accordance with organization policies.
• Communicate with multidisciplinary teams to promote continuity and efficiency in care delivery.
• Understand and apply principles of fiscal accountability in resource utilization.
• Participate in quality improvement initiatives and variance analysis to enhance patient outcomes.
• Perform additional duties as assigned by management.
  

✅ Qualifications

• Active RN license in good standing.
• Experience in inpatient utilization review or case management preferred.
• Familiarity with MCG (Milliman Care Guidelines) or similar criteria.
• Strong clinical judgment and communication skills.
• Ability to work independently in a remote environment.
  
  

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