Remote Hospital Utilization Management Nurse – Tennessee Clinical Review RN

Remote Hospital Utilization Management Nurse – Tennessee Clinical Review RN

Company: Volunteer State Clinical Review Services

Location: Tennessee, United States (Remote)

Volunteer State Clinical Review Services is seeking an experienced Utilization Management Nurse RN to perform clinical reviews, evaluate healthcare services, and support appropriate patient care decisions. This remote nursing position works with healthcare providers, insurance partners, and clinical teams to improve healthcare quality and resource utilization.

The Utilization Management Nurse reviews medical information, applies clinical guidelines, and communicates recommendations to support efficient and effective healthcare delivery.

Responsibilities

• Perform remote clinical utilization reviews
• Evaluate medical necessity documentation
• Review patient medical records
• Apply healthcare guidelines and criteria
• Communicate review outcomes with care teams
• Support quality and cost-effective care decisions
• Document clinical review activities
• Collaborate with physicians and healthcare professionals

Qualifications

• Active Registered Nurse (RN) license
• Clinical nursing experience required
• Utilization management experience preferred
• Strong clinical judgment skills
• Knowledge of healthcare regulations
• Excellent written communication skills

Preferred Experience

• Hospital nursing
• Utilization review
• Case management
• Insurance clinical review

Technology Used

• Electronic health records
• Clinical review platforms
• Healthcare authorization systems
• Secure communication tools

Schedule

Full-time remote nursing schedule with weekday hours and rotating review coverage.

Benefits

• Medical Insurance
• Dental Insurance
• Vision Insurance
• 401(k) Retirement Plan
• Paid Time Off
• RN License Support
• Continuing Education
• Performance Bonuses
• Remote Technology Package

Why Join Volunteer State Clinical Review Services?

Volunteer State Clinical Review Services partners with healthcare organizations to improve clinical decision-making and healthcare efficiency. Our remote nurses use their expertise to support better patient outcomes.

Volunteer State Clinical Review Services is an Equal Opportunity Employer. Applicants from Nashville, Memphis, Knoxville, Chattanooga, Clarksville, and communities throughout Tennessee are encouraged to apply.