Utilization Review Nurse – Utilization Management

ProMedica

Utilization Management RN maximizing quality and cost-efficiency of health care services at ProMedica. Collaborating with the healthcare team for reviews, authorizations, and service utilization improvements.

Posted 7/9/2026part-timeRemote • Ohio • 🇺🇸 United StatesMid-LevelSenior💰 $32 - $47 per hourWebsite

About the role

Key responsibilities & impact

maximize the quality and cost-efficiency of health care services at ProMedica
complete reviews for admissions and transfers
apply payer rules to obtain authorizations
work with physicians, nurses, and other members of the health care team
review cases and look for opportunities to improve hospital service utilization

Requirements

What you’ll need

Graduate of approved NLN accredited School of Nursing
Minimum of 3 years acute care nursing experience
Current RN licensed in the state of hire
Knowledge of insurance guidelines
experience with UR/UM in hospital acute care setting
Previous experience with case management
utilization review and InterQual criteria

Benefits

Comp & perks

dental
vision
company paid life insurance
paid time off
a 401k retirement plan
an employee assistance program
other voluntary coverage options
employee discounts

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Utilization ReviewCase ManagementPayer RulesInsurance GuidelinesAcute Care Nursing

Soft Skills

CollaborationCommunication

Certifications

RN License