Location: 100% REMOTE
Contract Duration: 12+ month [Possible Extension]
License Requirements: MI RN License
1. Mandatory Requirements to Apply
• Nursing Diploma or Associate Degree required; BSN preferred.
• 5+ years in healthcare/health-related fields.
• 3–5 years of Care Management and/or Utilization Management experience.
• Strong hands-on knowledge of InterQual criteria and utilization management.
• Experience with clinical reviews, staff training, quality management, and/or audits.
• Knowledge of ICD-10, CPT, CMS, NCQA, PA 60, and HIPAA.
• Strong communication, analytical, training, and project management skills.
• Proficiency with Microsoft Office, Teams, SharePoint, and healthcare systems.
2. Roles & Responsibilities
• Train and educate staff and provider facilities on InterQual criteria, clinical policies, utilization management, and departmental processes.
• Conduct clinical quality reviews and audits to support quality and regulatory requirements.
• Develop and update InterQual-focused training materials, manuals, and educational programs.
• Mentor new employees and work with leadership and subject matter experts to identify training needs.
• Support new systems, process improvements, accreditation activities, and quality initiatives.
3. Pay & Benefits
• $35–$39/hour
• 100% remote – Michigan residents only
• 9 days of Paid Time Off
• Health Insurance (Dental, Medical and Vision)
• All equipment provided by the client
Pay: $35.00 - $39.00 per hour
Benefits:
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance
Experience:
• Registered Nurse: 6 years (Required)
• Utilization Review: 4 years (Required)
• InterQual: 3 years (Required)
License/Certification:
• MI Registered Nurse License (Required)
Location:
• Michigan (Required)
Work Location: Remote