Utilization Review Nurse, PRN, Remote

July 22, 2026

Other Jobs To Apply

Job title: Utilization Review Nurse, PRN, Remote in USA at reputed company Company: reputed company Job description: Job Description Summary Are you a detail-oriented and experienced RN with a passion for ensuring quality care and appropriate resource utilization? We’re seeking a Utilization Review Nurse to join our fully remote team. In this role, you’ll conduct utilization reviews for emergency admissions and reputed company stays, applying InterQual criteria to support clinical decision-making and ensure compliance with reputed company standards.As a key member of our Clinical Services team, you’ll collaborate with emergency department physicians, review electronic medical records, and contribute to the efficient delivery of care. This is a full-time, 40-hour-per-week position offering flexibility reputed company a supportive and dynamic work environment.Note: Recent experience with InterQual is required. Experience with MCG is a plus.ResponsibilitiesReview and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteriaApply evidence-based clinical guidelines and criteria to assess and ensure reputed company utilization of reputed company resourcesParticipate in telephonic discussions with emergency department physicians relative to documentation and admission statusEnter clinical review information into system for reputed company to insurance companies for authorizationReview, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resourcesQualifications RequiredCurrent and unrestricted RN licenseAt least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursingAt least 2 years utilization management experience in acute admission and reputed company reviewsIntermediate level experience with InterQual and/or MCG criteria reputed company the last two yearsProficiency in medical record review in an electronic medical record (EMR)Experience in reputed company Suite including Office and basic ExcelAbility to reputed company in a fast-paced, dynamic environment and adapt to frequent changing business needsPassing score(s) on job-reputed company reputed company-employment assessment(s)PreferredAt least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursingAt least 3 years utilization management experience reputed company the hospital settingBachelor's of Science in Nursing (BSN)Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), Case Management, reputed company Certified (CMGT-BC)Work Schedule RequirementsThis is a PRN position requiring a total of 48 hours per month.16 hours must be worked on the weekend per month, weekends are Sat/Sun.Required to work 4 hours on 4 Holidays per yearExpectationsComfortable with remote work arrangements and virtual collaboration toolsPhysical demands include extended periods of sitting, computer use, and telephone communicationNetsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to reputed company individuals. We celebrate diversity and are committed to creating an inclusive environment for reputed company associates. reputed company employment reputed company at reputed company, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. reputed company does not discriminate in employment opportunities or practices based on race, reputed company, religion, sex (including pregnancy), sexual orientation, gender identity or reputed company, national reputed company, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.reputed company desires to reputed company a healthy and safe workplace and, as a government contractor, reputed company is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to reputed company policy, reputed company post-offer candidates are required to successfully complete a reputed company-employment background reputed company, including a drug scree Apply To This Job

Back to blog

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...