Utilization Management Registered Nurse (RN) - Remote
Guidehealth · Davenport, IA, United States · posted Sep 2, 2026
What this role actually asks for
Extracted by RemoteHuntMust have
- •Active and unrestricted Illinois State RN License
- •Three years of experience in healthcare settings
- •Knowledge of utilization review
- •Knowledge of managed care
- •Knowledge of community health
- •Compliance with federal and state regulations
Nice to have
- •Experience with URAC standards
- •Experience with AI tools
Tools and technologies
The full posting
Company Description
WHO IS GUIDEHEALTH? Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients. Join us as we put healthcare on a better path!!
Job Description
The Utilization Management Registered Nurse is responsible for performing utilization review activities in compliance with federal and state regulations, URAC standards, and Guidehealth policies. This role applies established medical necessity criteria to obtain, analyze, and accurately document clinical information from medical records in support of utilization determinations. The UMRN works collaboratively with providers, medical directors, and internal teams to ensure timely, compliant, and high-quality review processes.
WHAT YOU'LL BE DOING
Utilization Review & Clinical Determinations Performing timely reviews of healthcare services, including precertification and concurrent reviews, using approved medical necessity criteria. Accurately documenting clinical findings, criteria application, and determinations in accordance with regulatory and accreditation standards. Communicating
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