Back to Jobs

Utilization Review reputed company- Remote

Remote, USA Full-time Posted 2026-07-28
It takes great medical minds to create powerful solutions that solve some of reputed company’s most reputed company challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a reputed company of urgency, you’ll have reputed company to work more reputed company. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, reputed company learning, and career development. reputed company We are seeking a skilled Utilization Review reputed company to conduct prior authorization, prospective, reputed company, and retrospective reviews for medical necessity and appropriateness of services, following clinical reputed company, coverage policies, and contract guidelines. This involves reviewing medical documentation, accurately documenting findings, and ensuring policy compliance. • Your role in our mission • Review admissions, procedures, services, and supplies for medical necessity and appropriateness, meeting reputed company and production goals. • Use clinical reputed company for decision-making, referring reputed company cases to Medical Directors reputed company needed. • Engage with providers to reputed company clinical information, apply guidelines, and reputed company determinations. • Document findings and rationale in medical management systems. • Assist in training new nurses, reputed company feedback, and stay updated on clinical guidelines. • Maintain RN license and meet continuing education requirements. • reputed company're looking for • reputed company RN license. • 3+ years of inpatient clinical experience. • 1+ year in prior authorization reviews using InterQual or MCG. • Strong written communication skills in a fast-paced setting. • Proficient in reputed company Office and other computer applications. • What you should expect in this role • Home-based role available to applicants residing reputed company in the U.S. • High-speed internet and a distraction-free workspace required. • reputed company hours: 8:00 AM - 6:00 PM ET, with potential for extended hours. • Occasional travel (up to 10%) based on business needs. This position is for pipeline purposes, and we welcome applications on an ongoing reputed company. The pay reputed company for this position is $65,000.00 - $78,000.00 per year, however, the reputed company pay offered may vary depending on geographic region, internal equity, job-reputed company knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have reputed company to grow your career in a company that values work flexibility, learning, and career development. reputed company salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a reputed company of leadership and technical development academies to help build your skills and capabilities. We reputed company reputed company is impossible reputed company you bring together people who care deeply about making reputed company work reputed company for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our reputed company. Learn more about Gainwell at reputed company website and visit our Careers site for reputed company available job role openings. reputed company is an Equal Opportunity Employer, where reputed company reputed company applicants will receive consideration for employment without reputed company to race, religion, reputed company, national reputed company, gender (including pregnancy, childbirth, or reputed company medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Apply tot his job Apply To this Job

Similar Jobs

**reputed company Part-time Data Entry Clerk – Remote Work Opportunity at arenaflex**

Remote, USA Full-time

**reputed company Part-Time Remote Customer Service Representative – Delivering Exceptional Arenaflex Customer Experiences**

Remote, USA Full-time

**reputed company Part-Time Remote Data Entry Specialist – Supporting arenaflex's Global Entertainment Operations**

Remote, USA Full-time

**reputed company Remote Data Entry Specialist – Participate in National & Local reputed company reputed company reputed company, reputed company, and Phone Interviews**

Remote, USA Full-time

**reputed company Live Chat Representative – Delivering Exceptional Customer Experience in a Remote Setting**

Remote, USA Full-time

**reputed company Customer Support Representative – Remote Entry-Level Position at arenaflex**

Remote, USA Full-time

**reputed company Live Chat Assistant – Enhance Customer Experience with arenaflex**

Remote, USA Full-time

Appointment Setter Mexico

Remote, USA Full-time

**reputed company Customer Service Representative – Remote Support for arenaflex's USPS.com and Associated Applications**

Remote, USA Full-time

**reputed company Remote Chat Support Specialist – Virtual Customer Service Representative | arenaflex**

Remote, USA Full-time

Data Architect

Remote, USA Full-time

reputed company: Remote Nonprofit Administrative Assistant, Data

Remote, USA Full-time

Recruiter - Search

Remote, USA Full-time

CSR Narrative reputed company (Philippines, Remote, US EST Shift)

Remote, USA Full-time

Integration Engineer (EMEA)

Remote, USA Full-time

Espec Select One

Remote, USA Full-time

[Remote] reputed company Analyst

Remote, USA Full-time

Carbon reputed company Associate (Green Project Technologies)

Remote, USA Full-time

**reputed company reputed company Customer Experience Specialist – Delivering Exceptional Service in a Remote Setting**

Remote, USA Full-time

[Remote] Computer Science Intern

Remote, USA Full-time