Utilization Review Author-Remote

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industryu2019s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. The Utilization Review Specialist will be part of our Physician Advisory Team providing first level initial admission and continued stay case reviews. The Utilization Review Specialist will determine the appropriate cases for review, utilizing client specific guidelines. Upon identification of a case, the Utilization Review Specialist will ensure that appropriate orders and clinical documentation is in place prior to application of the evidence-based criteria. Responsibilities: + Perform initial admission and continued stay reviews utilizing InterQual and MCG using evidenced-based criteria to identify and support the appropriate level of care + Abstract data from a variety of medical records to ensure accurate clinical data + Adhere to established quality, timeliness, and productivity outputs required in the completion of first level nursing utilization review + Ensure effective communication internally and externally while delivering excellent customer service + Perform other duties as assigned by departmental leadership in support of departmental and organizational strategies and goals which may include system testing, training and other opportunities that promote growth + Complete and maintain annual compliance and annual HIPAA training + Participate in organizational educational offerings and required training as needed to support service delivery Required Qualifications: + Bacheloru2019s Degree + Must have a current Registered Nurse license + 2 years of recent hospital-based Utilization Review preferred + At least 3 years of clinical nursing experience (practice) + Knowledge of current Medicare rules and regulations related to Utilization Review + Strong analytical, organizational and time management skills + Ability to work independently with limited supervision + Excellent clinical abstraction and attention to detail + Experience with InterQual and/or MCG is preferred + Must be willing to work a variable schedule that encompasses evenings, days, weekends, and holidays. Hiring day shift: 8am-4pm and night shift 4pm-12am. Also, must be able to work 4 weekend days a month. For this US-based position, the base pay range is $65,500.00 - $96,885.29 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training. This job is eligible to participate in our annual bonus plan at a target of 10.00% The healthcare system is always evolving u2014 and itu2019s up to us to use our shared expertise to find new solutions that can keep up. On our growing team youu2019ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career. Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team u2014 including offering a competitive benefits package. ( R1 RCM Inc. (u201cthe Companyu201d) is dedicated to the fundamentals of equal employment opportunity. The Companyu2019s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any personu2019s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories. If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance. CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent (Consent Notice.pdf) To learn more, visit: Visit us on Facebook ( R1 is the leader in healthcare revenue management, helping providers achieve new levels of performance through smart orchestration. A pioneer in the industry, R1 created the first Healthcare Revenue Operating System: a modular, intelligent platform that integrates automation, AI, and human expertise to strengthen the entire revenue cycle. With more than 20 years of experience, R1 partners with 1,000 providers, including 95 of the top 100 U.S. health systems, and handles over 270 million payer transactions annually. This scale provides unmatched operational insight to help healthcare organizations unlock greater long-term value. To learn more, visit: .

Created: 2026-05-08