🛠 Tech Stack

💼 About This Role

You'll perform medical necessity reviews for inpatient, prior authorization, and retrospective cases. You'll collaborate with Medical Directors to ensure appropriate cost-effective care across Commercial, Medicare, and Medicaid lines of business. This role offers the chance to shape healthcare delivery at a rapidly growing company.

🎯 What You'll Do

• Review medical necessity for inpatient, concurrent, prior auth, and retrospective cases
• Collaborate with Medical Directors and providers to align on clinical decisions
• Document reviews accurately and meet production/quality goals
• Apply MCG, Cohere, and coverage guidelines for compliance

📋 Requirements

• Active, unencumbered RN license (state of residence)
• 3+ years of clinical experience
• Utilization Management experience
• Experience in acute or post-acute settings

✨ Nice to Have

• HEDIS abstraction, Legal RN, or Utilization Review background
• Bachelor's degree in Nursing, Business, or related field

🎁 Benefits & Perks

• 💻 Fully remote opportunity with about 5% travel
• 🩺 Medical, dental, vision, life, disability insurance and EAP
• 📈 401K retirement plan with company match; FSA and HSA
• 🏝️ Up to 23 days PTO per year + company holidays
• 👶 Up to 14 weeks paid parental leave

📨 Hiring Process

Estimated timeline: 1-2 weeks

1. 1Internet Speed Test· 15 min
2. 2Behavioral Interview(s) with Hiring Manager· 60 min

🚩 Heads Up

• Role mixes clinical review with quality improvement and accreditation tasks, potentially overloading scope
• Requires robust internet speed (50+ Mbps) and ability to stream video, which may be restrictive for remote work