Utilization Management Nurse

We're Hiring: Utilization Management Nurse (Evening Shift 11pm PST to 7:30am PST)

REMOTE

• Job Type: Full-Time (w/paid holidays after 90 days)
• Department: Utilization Management

About Us:

At bServed UM, we’re transforming the way healthcare organizations manage utilization. Our mission is to improve patient outcomes while helping hospitals and providers reduce costs. We specialize in lowering denial rates, optimizing length of stay, and supporting Case Management teams across hospitals, IPAs, and insurance companies.

The Role:

We are seeking a dedicated Utilization Management Nurse to join our growing team. You’ll play a key role in reviewing the medical necessity and appropriateness of care using clinical guidelines and collaborating with providers and payers to ensure efficient, effective patient care.

Key Responsibilities:

✅ Conduct prospective, concurrent, and retrospective reviews

✅ Apply InterQual criteria to support UM decisions

✅ Collaborate with providers and payers on authorizations and discharges

✅ Document and justify clinical decisions in compliance with regulations

✅ Support appeals, monitor high-cost cases, and promote cost-effective care

What We’re Looking For:

✔ Active LVN/RN license (State-specific or Compact)

✔ 2+ years clinical nursing experience (med-surg, acute, etc.)

✔ 2+ years in Utilization Review or Case Management experience required

✔ InterQual experience required

✔ Excellent communication, organization, and critical thinking

Bonus Points:

➕ BSN preferred

➕ CCM or UR certification

➕ Experience with Medicare, Medicaid, or commercial payers

Why Join Us?

✨ Make a real impact in healthcare

✨ Be part of an innovative, growing team

✨ Flexible work environment

✨ Competitive compensation

Job Type: Full-time

Pay: $26.00 - $30.00 per hour

People with a criminal record are encouraged to apply

Work Location: Remote