Part-Time Utilization Management RN

Part-Time Utilization Management RN (Remote – Saturdays Only) Schedule: Saturdays, 9:00 AM – 5:00 PM (Mandatory weekday training prior to start) Location: Fully Remote Employment Type: Part-Time We are actively seeking a Part-Time Utilization Management Registered Nurse (RN) to join our team. This role is ideal for an experienced RN with a background in utilization review who is looking for consistent weekend work in a fully remote setting. Position Summary: Under the direction of a designated Manager, the Utilization Management RN performs telephonic reviews of inpatient hospital admissions, evaluating the medical necessity of continued stays and identifying opportunities for timely discharge planning. This role plays a vital part in promoting high-quality, cost-effective healthcare and facilitating optimal transitions of care.

Conduct telephonic utilization reviews of inpatient admissions using established criteria. Assess medical necessity for inpatient and continued stay; recommend alternative levels of care when appropriate. Collaborate with attending physicians, hospital utilization departments, and discharge planners to support care coordination. Refer cases to Medical Directors when admissions do not meet criteria. Support early identification of discharge planning needs and help coordinate transitions to home or alternative settings. Refer patients to Case Management or Disease Management as needed. Identify quality of care concerns and refer to Quality Management when applicable. Ensure timely and accurate documentation in compliance with regulatory and accreditation standards. Provide outstanding customer service and contribute to ongoing provider education. Participate in reporting and trend analysis for utilization patterns or issues.