Utilization Review Nurse

Dane Street

Utilization Management Nurse Reviewer ensuring effective healthcare delivery at Dane Street. Reviewing medical records and treatment plans to optimize patient care and control costs.

Posted 7/30/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting medical service assessments and ensuring compliance with established guidelines, while effectively communicating with clinical and non-clinical staff. Proficient in managing clinical details within medical management platforms and maintaining up-to-date knowledge of regulatory standards.

Highest-signal resume keywords

Clinical AssessmentMedical Necessity ValidationUtilization Review ComplianceEffective CommunicationLVN/RN License

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical ReasoningPatient Record EvaluationEvidence-Based Guidelines ApplicationMedical Management PlatformsAttention to Detail

Soft Skills

Professional CommunicationOrganizational SkillsProblem SolvingMultitasking Ability

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft PowerPointMicrosoft Outlook

Certifications & Qualifications

Unrestricted LVN/RN License

Industry Keywords

CMS GuidelinesMilliman Care GuidelinesInterQualURACState Standards

About the role

Key responsibilities & impact

Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria).
Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services.
Offer clinical expertise and serve as a clinical reference for non-clinical staff members.
Input and manage essential clinical details within various medical management platforms.
Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review.
Apply clinical reasoning to determine the suitable evidence-based guidelines.
Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director.

Requirements

What you’ll need

Proficient in both written and spoken communication.
Capable of maintaining professional communication with physicians and clients.
Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting.
Possesses a keen organizational sense and pays close attention to details.
Adept at resolving intricate and multifaceted problems.
Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook.
Background in medical or clinical practice through education, training, or professional engagement.
Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs).

Benefits

Comp & perks

medical, dental, and vision coverage for you and your family.
voluntary life insurance options for you, your spouse, and your children.
other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans.
basic life insurance, short-term disability, and long-term disability coverage at no cost.
generous paid time off policy ensures you have time to relax and recharge.
401k plan with a company match helps you plan for your future.
Apple equipment and a media stipend are provided for remote workspace.