Utilization Management Registered Nurse (RN), Remote

Job overview

The Utilization Management Registered Nurse (RN), Remote role is remote; the listing location is Kenosha, WI. Compensation is $70,000–$75,000 per year. Guidehealth is a healthcare company focused on affordability, patient health, and supporting providers through managed services and data-driven tools. The nurse reviews clinical information against medical necessity criteria and communicates timely determinations, supporting compliant utilization review, care coordination, and quality improvement.

What you'll do

• Conduct precertification and concurrent reviews using approved medical necessity criteria
• document clinical findings and determinations
• communicate decisions to providers, members, and other parties
• collaborate with medical directors and peer reviewers
• refer patients to disease management or population health programs
• participate in quality management and performance improvement
• maintain confidentiality and regulatory compliance
• contribute feedback on AI tools used in daily workflows.

What we're looking for

Skills & competencies

registered nurse (rn)

utilization management

remote

guidehealth

$70k–$75k/year

utilization review

medical necessity

precertification

concurrent review

care coordination

population health

illinois rn license

remote work equipment

medical dental vision

Work arrangement

• Weekend coverage required

Benefits & perks

• Medical, dental, and vision plans
• 401(k) with 3% employer match to a 6% employee contribution
• life and disability insurance
• employee assistance program
• paid time off
• paid parental leave
• and learning and development resources.

Why this role

Guidehealth is fully remote and provides necessary work equipment; employees provide their own internet connection meeting the stated speed requirements. An active, unrestricted Illinois RN license and three years of healthcare experience are required.

About the employer

Guidehealth is hiring for this role. Industry: All Other Outpatient Care Centers. Sector: 62.