Nurse - Clinical Review
WNS Global Services · United States · US
Utilization Review
Remote
physician
Nurse
Demand86
Career growth62
Healthcare fit88
Remote potential100
Salary band
USD 65k – 75k
5-year outlook
Stable demand is likely for remote utilization-review nurses, especially those with InterQual/MCG and managed-care experience. Pay will vary by license type, state, employer, and production/QA performance; automation may streamline documentation but clinical judgment and regulatory review remain valuable.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-25
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- physician, Nurse
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth applying for nurses with prior authorization or utilization-review experience who want fully remote, non-bedside work. Less suitable for clinicians without that specific review background.
Who should apply
RNs or LPN/LVNs with 2+ years of prior authorization, precertification, utilization review, managed care, health plan, or workers' compensation review experience, especially those with InterQual/MCG knowledge and a compact license.
CV angle
Frame bedside and managed-care experience around medical necessity criteria, prior authorization decisions, clinical documentation, QA/audit performance, turnaround times, provider communication, and use of InterQual/MCG or coverage policies. Quantify case volume and accuracy only where real.
Skills to highlight
- Utilization review
- Prior authorization
- Medical necessity criteria
- InterQual/MCG
- Clinical documentation
- QA audit/calibration
- Provider communication
- Regulatory compliance (URAC/NCQA/HIPAA)
Role summary
Remote nurse reviewer performing prospective utilization review of prior authorization requests against clinical guidelines and payer policies, approving cases that meet criteria and referring others to physician reviewers.
We publish our own intelligence summary, never the full job description. Always confirm details with the employer when you apply.