Utilization Review Nurse - RN | 100% Remote | Part-Time| AT

10-20 Hours Per Week | Flexible Schedule | Evenings & Weekends

Looking for a way to use your nursing experience without returning to a full-time bedside schedule?

We're seeking an experienced Registered Nurse (RN) with Utilization Review/long-term care experience to join a healthcare team supporting patients and long-term care facilities in the Washington, DC and Maryland area.

This is a 100% remote, part-time position offering approximately 10-20 hours per week, with flexibility to work evenings and weekends. It's an excellent opportunity for an experienced nurse looking for a flexible schedule, supplemental work, or a way to stay clinically engaged outside of a traditional full-time role.

• 100% work from home - no office or facility visits required.
• Part-time: 10-20 hours per week.
• Flexible scheduling with evening and weekend availability.
• Use your clinical knowledge and nursing experience in a less traditional role.
• Review cases and documentation while helping support appropriate patient care and level-of-care decisions.
• Great opportunity for experienced RNs seeking work-life flexibility or supplemental hours.

• Conduct utilization management and quality reviews to evaluate medical necessity, patient acuity, and continued need for services.
• Review clinical documentation, care plans, and patient records for compliance with Medicare, Medicaid, PASRR, MDS, and other regulatory requirements.
• Evaluate appropriate levels of care and identify potential gaps or concerns.
• Collaborate virtually with providers, care teams, and other healthcare professionals.
• Support quality improvement, regulatory compliance, and appropriate utilization of services.
• Complete accurate and timely clinical reviews and documentation.
• Manage multiple cases while meeting established deadlines.

The ideal candidate has experience with:

• Utilization Review or Utilization Management
• Long-term care
• Admissions screening and care planning
• MDS
• Medicare and Medicaid criteria
• Continued stay reviews
• Quality improvement
• Clinical documentation review

Experience with Jiva or a similar medical management platform is a plus.