Location: 100% REMOTE
Contract Duration: 12+ month [Possible Extension]
License Requirements: MI RN License
1. Mandatory Requirements to Apply
- Nursing Diploma or Associate Degree required; BSN preferred.
- 5+ years in healthcare/health-related fields.
- 3–5 years of Care Management and/or Utilization Management experience.
- Strong hands-on knowledge of InterQual criteria and utilization management.
- Experience with clinical reviews, staff training, quality management, and/or audits.
- Knowledge of ICD-10, CPT, CMS, NCQA, PA 60, and HIPAA.
- Strong communication, analytical, training, and project management skills.
- Proficiency with Microsoft Office, Teams, SharePoint, and healthcare systems.
2. Roles & Responsibilities
- Train and educate staff and provider facilities on InterQual criteria, clinical policies, utilization management, and departmental processes.
- Conduct clinical quality reviews and audits to support quality and regulatory requirements.
- Develop and update InterQual-focused training materials, manuals, and educational programs.
- Mentor new employees and work with leadership and subject matter experts to identify training needs.
- Support new systems, process improvements, accreditation activities, and quality initiatives.
3. Pay & Benefits
- $35–$39/hour
- 100% remote – Michigan residents only
- 9 days of Paid Time Off
- Health Insurance (Dental, Medical and Vision)
- All equipment provided by the client
Pay: $35.00 - $39.00 per hour
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Experience:
- Registered Nurse: 6 years (Required)
- Utilization Review: 4 years (Required)
- InterQual: 3 years (Required)
License/Certification:
- MI Registered Nurse License (Required)
Location:
Work Location: Remote
