Utilization Review Nurse RN


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Reference Code: 5711

Utilization Review Nurse RN

Location: Cincinnati, OH 45246
Job Type: Contract 
Duration: 3 months, possibility of extension
Pay Rate: $32.00/hour

Our client, a Fortune 500 multi-state healthcare organization, is looking to hire a Utilization Review Nurse who will be responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing members with the right care at the right place at the right time.


  • The Utilization Review Nurse role is 100% remote; however, he/she must be in the EST zone.
  • Schedule after Training/Orientation: M-F 10-6:30pm EST
  • Day to Day Responsibilities: The Utilization Review Nurse processes authorization requests using approved criteria. The Utilization Review Nurse understands CMS compliance UM emergent and standard organization determination and for member notification of the EOD/SOD. The Utilization Review Nurse must also facilitate care coordination for members who have Medicare and Medicaid coverage. The Utilization Review Nurse must also effectively manage Medicare and MMP care transitions.

Job Qualifications:

  • The The Utilization Review Nurse must have an active, unrestricted RN license in the state of Ohio
  • The Utilization Review Nurse must have strong experience in In-Patient skilled nursing facility operations and strong experience with all levels of care coordination – LTAC, acute inpatient, etc.
  • The Utilization Review Nurse must have health plan Medicare UM experience and skilled in using MCG criteria (experience with QNXT preferred)
  • The Utilization Review Nurse must also touch type/keyboard and must be able to navigate multiple computer systems and Microsoft products (Outlook, Word, Excel, etc.)

For more information, please call our Recruiter directly at (847)278-8615. To submit your application, click on the 'Apply for Job' link below or send your resume directly to rod.ira@bluestonestaffing.com.

blueStone Staffing recruits top talent for some of the most desired companies on a contract, contract-to-hire and direct hire basis. We take pride in presenting our candidates with great opportunities they may not have exposure to elsewhere. By working with blueStone, you'll have access to rewarding job opportunities, competitive compensation, and industry leading benefits packages. We look forward to helping you land your next career opportunity and achieving your goals!


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