Utilization Review Clinician
Premera Blue Cross · United States · US
Utilization Review
Remote
physician
Nurse
Dentist
Demand85
Career growth70
Healthcare fit88
Remote potential95
Salary band
USD 80k – 126k
5-year outlook
Stable payer-side utilization review roles generally offer competitive RN salaries with potential growth into lead, manager, medical policy, or quality roles. Exact compensation will depend on location, licensure, and experience.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-09-28
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- physician, Nurse, Dentist
- 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
Strong fit for RNs with utilization review or managed care experience seeking remote payer-side work. Less suitable for clinicians without active RN licensure or prior utilization review exposure.
Who should apply
Registered Nurses with 3+ years of clinical experience, especially in acute care, case management, prior authorization, or managed care, and those with WA or compact licensure.
CV angle
Frame clinical experience as evidence of medical necessity judgment, application of clinical criteria, documentation accuracy, and cross-functional collaboration. Highlight any prior authorization, InterQual, utilization management, quality, or compliance work, and quantify review volumes or turnaround times where possible.
Skills to highlight
- Utilization review
- Medical necessity determination
- InterQual criteria
- Prior authorization
- Concurrent and retrospective review
- Clinical documentation
- Regulatory compliance
- Care coordination
Role summary
Remote payer-side utilization review RN evaluating prior authorization, admission, concurrent, and retrospective requests against medical policies and InterQual criteria, consulting with Medical Directors and supporting compliant utilization management workflows.
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