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Reference: #703799

Utilization Review Nurse (RN)


Posted : March 1, 2021

Job Type : Contract

Category : Healthcare


    Judge Healthcare is currently seeking a REMOTE Utilization Review RN for one of our top healthcare clients!

    Position details:

    • Location: REMOTE, but must reside in the state of Texas
    • Start Date: ASAP

    • Duration: 4 months with the possibility to extend
    • Hours: 9am – 6pm CST/ Monday – Friday and rotating Saturday shift


    Job Requirements:

    •  Performs utilization review activities, including pre-certification, concurrent, and retrospective reviews according to guidelines
    • Determines medical necessity of each request by applying appropriate medical criteria to first level reviews and utilizing approved evidenced based guidelines / criteria
    • Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services
    • Answers Utilization Management directed telephone calls; managing them in a professional and competent manner
    • Refers case to a review physician when the treatment request does not meet necessity per guidelines, or when guidelines are not available. Referrals must be made in a timely manner, allowing the review physician time to make appropriate contact with the requesting provider in accordance with departmental policy and within CMS or URAC mandated turnaround times
    • Identify and refer potential cases to Disease Management and Case Management

    .Job Requirements:

    • Current, unrestricted Texas RN license or compact license
    • Reside in the state of Texas 
    • 2+ years of experience in managed care OR 5+ years nursing experience
    • Ability to interact productively with individuals and with multidisciplinary teams with minimal guidance

    All interested and qualified candidates can apply directly to Sheden Medhanie at, or call Sheden at (972) 966-0936 for immediate consideration.

Apply now

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