Remote Utilization Review RN (Evening Shift) – TRICARE/InterQual ⭐

Make a Difference While Working From Home!

White Stone Healthcare Resources is seeking an experienced Utilization Review Registered Nurse (RN) to join our team in a 100% remote, permanent evening shift position supporting the TRICARE program.

As a Utilization Review RN, you will play a vital role in ensuring active-duty military members, veterans, retirees, and their families receive medically necessary, high-quality, and cost-effective healthcare services. Using your clinical expertise and InterQual criteria, you'll make evidence-based utilization review determinations that directly impact patient care and healthcare outcomes.

If you're looking for a meaningful opportunity to use your Utilization Management experience while working from home, we'd love to hear from you.

Position Details

REQ-ID: 26-12

Salary: $83,000–$92,000 annually, based on experience and qualifications.

Employment Type: Full-Time | Permanent | 100% Remote

Schedule: Monday–Friday | Evening Shift

Applicants must be available to work the following schedule in their time zone.

  • 11:00 AM – 8:00 PM Pacific Time
  • 1:00 PM – 10:00 PM Central Time
  • 2:00 PM – 11:00 PM Eastern Time

Why Join White Stone?

At White Stone Healthcare Resources, we believe our employees are our greatest asset. As a Service-Disabled Veteran-Owned Small Business (SDVOSB), we've proudly supported the Department of Defense, Veterans Affairs, Indian Health Service, and private healthcare organizations since 2004.

When you join White Stone, you'll enjoy:

  • ✔ 100% Remote Work
  • ✔ Full-Time, Permanent Employment
  • ✔ Monday–Friday Schedule
  • ✔ Competitive Salary
  • ✔ Comprehensive Benefits Package
  • ✔ Collaborative Leadership Team
  • ✔ Opportunity to Support Military Members, Veterans, and Their Families
  • ✔ Stable Government Healthcare Contract

Benefits

White Stone Healthcare Resources offers a comprehensive benefits package that includes:

  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • Life Insurance
  • Short-Term Disability Insurance
  • Long-Term Disability Insurance
  • Accidental Death & Dismemberment Insurance
  • 401(k)
  • Flexible Spending Account (FSA)
  • Employee Assistance Program (EAP)
  • Generous Paid Time Off
  • Direct Deposit

What You'll Do

In this role, you will:

  • Review medical records to determine medical necessity and appropriate utilization of healthcare services.
  • Perform preauthorization, concurrent, inpatient, and continued stay reviews for Medical/Surgical and Behavioral Health cases.
  • Apply InterQual® criteria and TRICARE policies to make clinical determinations.
  • Evaluate benefit coverage, quality of care, level of care, and appropriate length of stay.
  • Document clinical determinations within the medical management system.
  • Present complex cases to the Medical Director for review.
  • Refer appropriate cases to Case Management and Disease Management.
  • Provide clinical guidance regarding utilization review and coding questions.
  • Conduct pre-admission screenings and clinical assessments.
  • Promote high-quality, cost-effective healthcare while ensuring appropriate utilization of resources.

Minimum Qualifications Required

  • Current, unrestricted Registered Nurse (RN) license
  • Minimum two (2) years of Utilization Management/Utilization Review experience
  • Minimum two (2) years of clinical nursing experience in a medical facility
  • Experience using InterQual®
  • United States citizenship
  • Ability to obtain and maintain a favorable Interim and Final Department of Defense (DoD) background investigation
  • Proficiency with Microsoft Office and general computer applications
  • Excellent verbal and written communication skills
  • Private home office with a door to maintain confidentiality
  • Secure, hard-wired high-speed internet connection (minimum 30 Mbps download / 10 Mbps upload)

Preferred

  • Three (3) or more years of Medical/Surgical nursing experience
  • Three (3) or more years of Behavioral Health experience
  • Two (2) or more years of experience applying TRICARE policies
  • Managed Care experience
  • Compact RN License

Who We're Looking For

The ideal candidate is:

  • Detail-oriented and organized
  • Self-motivated and comfortable working independently
  • Able to prioritize multiple deadlines in a fast-paced environment
  • A strong critical thinker with sound clinical judgment
  • Passionate about delivering exceptional service to military members and their families

Physical Requirements

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of this position.

This position requires the ability to:

  • Sit for extended periods while working at a computer.
  • Use a keyboard, mouse, and other technology for prolonged periods.
  • Communicate effectively by telephone, video conference, and written correspondence.
  • Perform repetitive hand and finger movements.
  • Maintain close and color vision.
  • Maintain regular and reliable attendance.

About White Stone Healthcare Resources

White Stone Healthcare Resources, LLC is a Service-Disabled Veteran-Owned Small Business (SDVOSB) dedicated to providing exceptional healthcare staffing solutions nationwide.

Since 2004, we've partnered with the Department of Defense, Veterans Affairs, Indian Health Service, and private healthcare organizations to deliver exceptional clinical talent. Our reputation is built on responsiveness, integrity, employee satisfaction, and outstanding customer service. We invite you to read our Google reviews to learn why healthcare professionals choose White Stone.

Equal Opportunity Employer

White Stone Healthcare Resources is proud to be an Equal Opportunity Employer and an E-Verify participant.

We recruit and hire qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, protected veteran status, or any other characteristic protected by applicable law.

Disclaimer

The information contained in this job posting is intended to describe the general nature and level of work performed. It is not intended to be an exhaustive list of all duties, responsibilities, or qualifications. Duties and responsibilities may be modified as business needs evolve.

Cooperative, professional, and respectful conduct is an essential function of every position. Employees are expected to work collaboratively with colleagues, clients, and leadership while demonstrating integrity, accountability, and professionalism in all interactions.

Pay: $83,000.00 - $92,000.00 per year

Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Disability insurance
  • Employee assistance program
  • Flexible spending account
  • Health insurance
  • Health savings account
  • Life insurance
  • Paid time off
  • Retirement plan
  • Tuition reimbursement
  • Vision insurance

Application Question(s):

  • What is your permanent state of residence?
  • If selected for employment, are you able to provide documentation verifying your U.S. citizenship (e.g., a U.S. passport, birth certificate, or Certificate of Naturalization)?

Experience:

  • direct patient care clinical: 2 years (Required)
  • Utilization review: 2 years (Preferred)
  • Behavioral health: 3 years (Preferred)
  • Medical-surgical: 3 years (Preferred)
  • InterQual: 1 year (Required)
  • utilization review using TRICARE Policy Manuals: 2 years (Preferred)
  • Managed Care: 1 year (Required)

Language:

  • fluent English (Required)

License/Certification:

  • Current and unencumbered Registered Nurse License (Required)

Security clearance:

  • Confidential (Preferred)

Shift availability:

  • Night Shift (Required)

Work Location: Remote

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