Utilization Management Nurse New

IntePros is seeking an experienced Utilization Management Nurse to join a leading insurance organization. This 100% remote role is ideal for a nurse with Outpatient Services utilization management experience who holds an active PA or compact Nursing License. In this position, you’ll apply InterQual criteria to review medical records, determine medical necessity, and collaborate with providers to ensure patients receive the right level of care, all while maintaining compliance with state, federal, and accreditation standards.

What You’ll Do

• Review medical records and determine medical necessity using InterQual and medical policy criteria.
• Collaborate with providers to clarify treatment plans and ensure appropriate levels of care.
• Identify discharge planning needs and coordinate with case management teams.
• Maintain compliance with state, federal, and accreditation regulations.
• Ensure accurate documentation and timely processing of authorization requests.

What We’re Looking For

• Active RN (required).
• 3+ years of Outpatient Services experience (bedside or utilization management).
• Prior utilization management experience (required).
• Strong critical thinking, communication, and organizational skills.
• Proficiency with Microsoft Office Suite, SharePoint, and InterQual.