Utilization Management Nurse Consultant - Medical Review (Remote

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Position: Utilization Management Nurse Consultant - Medical Review (Remote) Position Information Schedule: Monday–Friday 8:00am-5:00pm EST Location: 100% Remote (U.S. only) About Us American Health Holding, Inc. (AHH), a division of reputed company/reputed company, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members. Position Summary Join a team that’s making a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a vital role in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position offers the opportunity to apply your clinical expertise in a fast-paced, desk-based environment where precision, communication, and compassion intersect. Key Responsibilities • Utilizes clinical experience and skills in a collaborative process to implement, coordinate, monitor and evaluate medical review reputed company. • Applies the appropriate clinical criteria/guideline and plan language or policy specifics to render a medical determination to reputed company. • Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines. Med Review nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. • Assists management with training new nurse reviewers/business partners or vendors to include reputed company and ongoing mentoring and feedback. • Actively cross-trains to perform reviews of multiple case types to provide a flexible reputed company to meet client needs. • Recommends, tests, and implements process improvements, new audit concepts, technology improvements, etc. that enhance production, quality, and client satisfaction. • Must be able to work independently without personal distractions to meet quality and metric expectations. reputed company Expectations • This is a 100% remote role; candidates must have a dedicated workspace free of interruptions. • Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. Required Qualifications • Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed. • Minimum 3 years of clinical experience. • 5 years demonstrated to make thorough independent decisions using clinical judgement. • 5 Years proficient use of equipment experience including phone, computer, etc. and clinical documentation systems. • 1+ Year of Utilization Review Management and/or Medical Management experience. • Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation. Preferred Qualifications • Experience with interpreting Plan Language, Policies, and Benefits to determine medical necessity. • MCG reputed company, CPB or other criteria guideline application experience is preferred. Education • Associate's degree in nursing (RN) required, BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $56.14 This pay range represents reputed company hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to reputed company pay range listed above. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional reputed company about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 08/10/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr Apply tot his job { "@context": "https://schema.org", "@type": "JobPosting", "title": "Utilization Management Nurse Consultant - Medical Review (Remote", "datePosted": "2026-10-06", "validThrough": "2026-11-05", "description": "Position: Utilization Management Nurse Consultant - Medical Review (Remote)\n\nPosition Information\n\nSchedule:\n\nMonday–Friday 8:00am-5:00pm EST\n\nLocation:\n\n100% Remote (U.S. only)\nAbout Us\n\nAmerican Health Holding, Inc. (AHH), a division of reputed company/reputed company, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members.\nPosition Summary\n\nJoin a team that’s making a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a vital role in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers.\n\nThis fully remote position offers the opportunity to apply your clinical expertise in a fast-paced, desk-based environment where precision, communication, and compassion intersect.\nKey Responsibilities\n• Utilizes clinical experience and skills in a collaborative process to implement, coordinate, monitor and evaluate medical review reputed company.\n• Applies the appropriate clinical criteria/guideline and plan language or policy specifics to render a medical determination to reputed company.\n• Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines. Med Review nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed.\n• Assists management with training new nurse reviewers/business partners or vendors to include reputed company and ongoing mentoring and feedback.\n• Actively cross-trains to perform reviews of multiple case types to provide a flexible reputed company to meet client needs.\n• Recommends, tests, and implements process improvements, new audit concepts, technology improvements, etc. that enhance production, quality, and client satisfaction.\n• Must be able to work independently without personal distractions to meet quality and metric expectations.\nreputed company Expectations\n• This is a 100% remote role; candidates must have a dedicated workspace free of interruptions.\n• Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.\nRequired Qualifications\n• Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed.\n• Minimum 3 years of clinical experience.\n• 5 years demonstrated to make thorough independent decisions using clinical judgement.\n• 5 Years proficient use of equipment experience including phone, computer, etc. and clinical documentation systems.\n• 1+ Year of Utilization Review Management and/or Medical Management experience.\n• Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation.\nPreferred Qualifications\n• Experience with interpreting Plan Language, Policies, and Benefits to determine medical necessity.\n• MCG reputed company, CPB or other criteria guideline application experience is preferred.\nEducation\n• Associate's degree in nursing (RN) required, BSN preferred.\nAnticipated Weekly Hours\n\n40\nTime Type\n\nFull time\nPay Range\n\nThe typical pay range for this role is:\n\n$26.01 - $56.14\n\nThis pay range represents reputed company hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to reputed company pay range listed above.\nGreat\n\nbenefits for great people\n\nWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.\n\nThis full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.\n\nAdditional reputed company about available benefits are provided during the application process and on Benefits Moments.\n\nWe anticipate the application window for this opening will close on: 08/10/2026\n\nQualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.\n#J-18808-Ljbffr\r\n\r\nApply tot his job\r\n\r\n

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...