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3h ago Curated

RN Utilization Review

Sedgwick

Job description

The RN Utilization Review position at Sedgwick involves reviewing medical records and applying clinical criteria to determine medical necessity for healthcare services. This is a fully remote role requiring an active RN license and at least 3 years of clinical experience. The role focuses on prior authorization, concurrent review, and retrospective review using MCG or InterQual guidelines. No direct patient care is involved. Salary range: $65,000–$85,000.

Key responsibilities

  • Review medical records for medical necessity
  • Apply MCG/InterQual criteria for prior authorization
  • Conduct concurrent and retrospective reviews
  • Communicate with providers and internal teams

What you bring

  • Active RN license (compact accepted)
  • 3+ years clinical experience
  • Knowledge of MCG or InterQual
  • Strong clinical judgment

Tags

100% RemoteUtilization ReviewCompact RN

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