FULLY REMOTE ROLE . Must have XSOLIS/Dragonfly experience and 1 year working in remote UR role recently to be considered.

Utilization Review Nurse
in Healthcare + Life Sciences ContractJob Detail
Job Description
Key Responsibilities:
- Conduct timely and accurate reviews of inpatient and outpatient medical records to determine medical necessity and level of care.
- Apply evidence-based criteria (e.g., InterQual, MCG) and hospital policies to support clinical decision-making.
- Communicate with physicians and clinical staff to clarify documentation and support utilization decisions.
- Submit clinical reviews to insurance companies and respond to requests for additional information.
- Monitor patient status and ensure appropriate documentation for continued stay reviews.
- Maintain compliance with federal, state, and payer-specific regulations.
- Accurately document all review activities in the hospital’s electronic medical record (EMR) and UR platforms (e.g., XSOLIS/Dragonfly).
Qualifications:
- Active and unrestricted Registered Nurse (RN) license in the state of California.
- Minimum of 2 years of recent Utilization Review experience, with at least 1 year of remote UR experience within the last 12 months.
- Proficiency with XSOLIS/Dragonfly platforms.
- Strong knowledge of utilization management principles and payer requirements.
- Excellent critical thinking, communication, and time management skills.
- Ability to work independently in a remote environment with minimal supervision.
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