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RN Utilization Review – Remote


This is a Contract position in Boulder City, NV posted November 23, 2021.

Cortex is looking for a REMOTE Utilization Review RN to match with a fantastic job!

Salary: $85,000 per year


Current Nevada RN License

Located near Las Vegas & able to meet in the office on occasion, but do most work remote

RN Bachelor’s (Required)

Utilization review: 1 year (Required)

Clinical nursing experience (2-4 years)

Experience in care or utilization management (2+ years)

Job Description

Utilization Review Nurse Duties and Responsibilities

  • Review new referral emails and make a decision on acceptance (within one hour of receiving a referral), if declining, provide explanation via email.
  • Balance quality of care with cost efficiency
  • Compile and review medical information and insurance coverage (example: PHCN)
  • Authorize requested medical services
  • Refer to for estimated revenue for Medicare/Medicare advantage plans
  • Identify alternative, cost-effective resources
  • Monitor staff utilization in regards to visit allowance assigned and staff compliance to the assigned visits.
  • Calculate visit limits for each discipline based off of analysis, and inform field staff of the visit limits for each 30-day window in the cert period.
  • Maintain UR excel spreadsheet to track the following for patients as they are accepted:
  • 1″8/2″d 30-day period date ranges
  • 1″&2″ 30-day period visit allowance vs actual visits completed
  • LUPA days
  • Assigned disciplines
  • Estimated vs actual revenue
  • Monitor staff documentation to ensure continued appropriateness of visits and address staff as needed.
  • One week of admin on call per month Monday-Sunday.

Cortex is looking for a Utilization Review RN that is:
A Team Player

Join us! In addition to applying, we invite you to copy & paste the link below to become a member of the Cortex RN Community, a community and job board exclusively for Registered Nurses. The Cortex RN Community is determined to find you a fantastic job, be it at Cortex or with one of our fabulous partners.

Join us in the Cortex RN Community

Cortex’s Recruiting Manager will text you shortly after applying!

We look forward to helping you find a great job!

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