Job Overview
Location
Remote, USA
Job Type
Full-time
Category
Data Science
Date Posted
May 7, 2026
Full Job Description
đź“‹ Description
- • The Utilization Review Specialist will be part of the Physician Advisory Team providing first level initial admission and continued stay case reviews, determining appropriate cases for review using client-specific guidelines and ensuring proper orders and clinical documentation are in place before applying evidence-based criteria.
- • Day to day responsibilities include performing initial admission and continued stay reviews using InterQual and MCG evidence-based criteria to identify and support the appropriate level of care, abstracting data from various medical records to ensure accurate clinical data, adhering to quality, timeliness, and productivity standards, and maintaining effective internal and external communication while delivering excellent customer service.
- • R1 RCM Inc. is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups, combining deep expertise of a global workforce of revenue cycle professionals with advanced technology platforms including analytics, AI, intelligent automation, and workflow orchestration.
- • The role offers opportunities to participate in organizational educational offerings, required training, system testing, and other growth-promoting activities, while contributing to meaningful work that improves patient care and supports community engagement through a culture of innovation and continuous learning.
🎯 Requirements
- • Bachelor’s Degree
- • Current Registered Nurse license
- • At least 3 years of clinical nursing experience
- • Knowledge of current Medicare rules and regulations related to Utilization Review
- • Experience with InterQual and/or MCG is preferred
- • Ability to work independently with limited supervision
- • Strong analytical, organizational, and time management skills
- • Willingness to work a variable schedule including evenings, days, weekends, and holidays, with ability to work 4 weekend days per month
🏖️ Benefits
- • Eligibility to participate in annual bonus plan at a target of 10.00%
- • Competitive benefits package
- • Opportunities for organizational educational offerings and required training
- • Chance to contribute to meaningful work that improves patient care and supports community engagement
- • Commitment to equal employment opportunity and a harassment-free workplace
- • Access to professional growth through system testing, training, and career development opportunities
Skills & Technologies
About R1 RCM Inc.
R1 RCM Inc. provides technology-driven revenue cycle management services to hospitals, health systems, and physician groups across the United States. The company offers end-to-end solutions spanning patient registration, coding, billing, claims processing, denial management, and collections, supported by analytics, automation, and outsourced staffing. Its cloud-based platform integrates with electronic health records to improve cash flow, reduce administrative costs, and ensure compliance with evolving healthcare regulations, serving a diverse client base that includes large health systems and academic medical centers.
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