Utilization Review Nurse — Remote, United States

Summit Medical Staffing is hiring a full-time remote Utilization Review Nurse in the United States. In this role, you will conduct clinical assessments to evaluate the necessity and appropriateness of healthcare services, support regulatory compliance, and help improve patient care outcomes. This position offers the opportunity to contribute to a critical area of healthcare while working with nurses, healthcare providers, and administrative staff.

Key Responsibilities

• Assess clinical information to determine the necessity and appropriateness of healthcare services.
• Review patient records and treatment plans for compliance with applicable healthcare regulations and guidelines.
• Contact healthcare providers to request additional clinical information when needed.
• Analyze patient data to identify utilization trends and opportunities to improve services.
• Document assessments and decisions clearly and accurately in accordance with regulatory standards.
• Collaborate with nursing and healthcare teams to support optimal patient outcomes.
• Independently manage an assigned caseload and meet deadlines.

Required and Preferred Qualifications

• Bachelor’s degree in nursing.
• Strong clinical assessment skills and critical thinking ability.
• Knowledge of healthcare regulations.
• Excellent communication and interpersonal skills.
• Ability to work independently and manage time effectively.
• Utilization review experience is preferred but not required.

Work Environment and Reporting

You will work with healthcare professionals, including nurses and administrative staff, and report to the Utilization Review Manager. Your assessments will support patient care quality and regulatory compliance. This position is remote and based in the United States.

Related Opportunities

• Data Entry Manager
• Customer Service Representative
• Project Coordinator