Utilization Management RN
Austin, TX
American Traveler
5x8 hrs, Days

Assignment Overview

• Shift: Days, 5x8hrs
• Hours: 40 hrs/wk
• Start Date: Oct 13, 2026
• Length: 13 weeks
• Openings: 1

Description

American Traveler is hiring a Utilization Management RN for a fully remote position requiring 2 years of acute care UM experience and proficiency with InterQual/MCG criteria.

Details

• Fully remote Utilization Management position within a centralized department overseeing acute admission utilization review across 13 acute care and critical access hospitals
• Schedule is 08:30-17:00
• Uses Cerner with Careport (Allscripts) EMR system
• No floating required

Requirements

• Active RN license (multistate or TX)
• BLS certification (AHA) required
• Minimum 2 years acute care utilization management experience or equivalent
• Proficiency with InterQual/MCG criteria and CMS regulations required
• Experience with payor portals, managed Medicare/Medicaid insurers, and Google Workspace preferred
• Remote work experience preferred
• Must be proficient and adaptable with multiple technologies simultaneously
• Nursys verification and primary source license verification required within 30 days prior to start

Additional Information

• Review admissions and service requests for prospective, concurrent, and retrospective medical necessity and reimbursement policy compliance
• Provide case management and consultation for complex cases
• Assist departmental staff with coding, medical records documentation, precertification, reimbursement, and claim denial/appeal issues
• Assess and coordinate discharge planning needs with healthcare team members
• Prepare statistical analysis and utilization review reports as needed
• Oversee and coordinate compliance with federally mandated and third-party payer utilization management rules and regulations
• Requires critical thinking, decisive judgment, and ability to work independently in a fast-paced environment
• Must possess a US Social Security Number and provide a US home address
• Local candidates accepted at a reduced rate under facility radius rule