Job description:
100% Remote | Michigan RN License Required | 12-Month Contract
1. Mandatory Requirements to Apply
• Active, unrestricted Michigan RN license.
• Nursing Diploma or ADN required; BSN preferred.
• 5+ years healthcare experience.
• 3–5 years Utilization Management experience.
• Experience with InterQual and/or MCG criteria.
• Knowledge of CMS, NCQA, HIPAA, ICD-10 and CPT codes.
• Strong communication, analytical, training, and project management skills.
2. Roles & Responsibilities
• Conduct clinical quality reviews and support Care Management and/or Utilization Management programs.
• Train and mentor staff on managed care, clinical policies, procedures, and InterQual criteria.
• Develop and update training materials and support new system/process implementations.
• Coordinate internal/external audits, quality initiatives, and accreditation activities.
• Partner with leadership and subject matter experts to improve training and performance.
3. Pay & Benefits
• $35–$39/hour
• 9 days of PTO
• Medical, dental & vision insurance
• All Equipment provided
Pay: $35.00 - $39.00 per hour
Expected hours: 40.0 per week
Benefits:
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance
Experience:
• Registered Nurse : 6 years (Required)
• Utilization Review/Utilization Management: 4 years (Required)
• InterQual: 3 years (Required)
License/Certification:
• Michigan State Registered Nurse (Required)
Location:
• Michigan (Required)
Work Location: Remote