Devoted Health
Clinical Guide Part A: (UM) Utilization Management Nurse
$83K–$96K
Remote USA · Full-time · Posted Oct 19, 2026
- Experience
- Minimum 4 years of clinical experience; 3+ years in one or more listed utilization, case management, discharge planning, care coordination, or appeals areas.
About the job
Conducts utilization reviews for inpatient, behavioral health, and post-acute services, assessing medical necessity and compliance with CMS and Medicare Advantage requirements.
What you'll do
- Review medical records and treatment plans to determine medical necessity, level of care, and appropriate services.
- Conduct inpatient, behavioral health, and post-acute authorization reviews, including discharge reviews and issuing NOMNC when applicable.
- Refer cases for Medical Director review, prepare clinical summaries, and maintain compliant documentation.
What they ask for
- Unrestricted RN license and at least 4 years of clinical experience.
- At least 3 years in utilization review, utilization management, case management, discharge planning, care coordination, or clinical appeals.
- Familiarity with CMS regulations and Medicare Advantage requirements, or comparable payer coverage experience.
- Experience escalating cases that do not meet criteria and preparing clinical summaries for physician review.
Nice to have
- Experience with AI/LLM.
- Certified in InterQual.
Pay
$82,680-$96,460 USD / year (base salary)
Tools
AI/LLM, InterQual
AI focus
AI/LLM experience is desired; the posting does not describe specific AI duties.
Model-written summary · the original posting is authoritative