Utilization Management Specialist (UM / Utilization Review Nurse) — Remote
Location: 100% Remote (U.S.) — Maryland compact/eligibility required
Type: Contract (approx. 3 months; potential extension)
Schedule: Mon–Fri, 8:00am–5:00pm ET (1-hour lunch) - Flex after ramp-up start time between 7:00am–9:00am ET
Pay (W2): USD 51.00/H
Job overview
In this role, you’ll use your clinical background and utilization management experience to review requests for care and determine medical necessity, appropriateness, and benefit coverage. You’ll work fully remote and leverage MCG, medical policy, and regulatory guidelines while collaborating with Medical Directors and internal teams to support timely, accurate authorization decisions.
What you’ll do

+ Perform prospective, concurrent, and retrospective utilization reviews (medical + behavioral health).

+ Make medical necessity / appropriateness determinations and support prior authorizations.

+ Us...