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

cGNRMEhvYkxsQ25QRWZHWVlubEoxOXQrWmc9PQ==
  • 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

ExecutivePlacements.com

Data Scientist (REMOTE) Job at ExecutivePlacements.com

 ...Essential Responsiblities May Include Execute data science projects as identified by Sr Data Scientists,...  ...#Datascientist Work environment requirements for entry-level opportunities include Physical: Computer keyboarding Auditory/visual: Hearing, vision and... 

Hampton Behavioral Health Center

MUSIC, RECREATION OR ART THERAPIST- PER DIEM Job at Hampton Behavioral Health Center

 ...Hampton is currently looking for a Per Diem Music or Recreation or Art Therapist. Please visit our website for more information:...  ...direct patient care on assigned units; including Creative Therapy group sessions and doctor ordered individual assessments sessions... 

Lafrance Hospitality

YEAR ROUND - Bartender / Bistro Attendant - Fairfield, North Conway, NH Job at Lafrance Hospitality

 ...Ensure cleanliness and organization of the bar area Handle cash and process payments Provide excellent customer service and...  ...communication skills Ability to multitask and work efficiently under pressure TIPS certification is preferred Benefits... 

A well-established and rapidly growing game development and ...

Cocos Creator Game Developer Job at A well-established and rapidly growing game development and ...

Cocos Creator Game DeveloperWe are assisting our client, a well-established and rapidly growing game development and operations company, in recruiting a Cocos Creator Game Developer in Taiwan.Work Location: Remote reporting to Hong Kong at the beginning, will have office... 

Hyatt

PM Houseperson - Events (Banquet Set-Up) Job at Hyatt

 ...as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.**Why Choose Hyatt?**At Hyatt, your success matters. We offer:+ **Competitive Salary:** $16.25/hour+ **Health Benefits:** Medical, dental, and vision...