REMOTE - RN Utilization Review / Medical Review

Job Description

Registered Nurse (Utilization Review / Medical Review) #74950

Employment Type: Full-Time

Location: Remote, local candidates

Candidate Location Preference: Austin and surrounding areas

Schedule and Work Hours

Required availability: Between 7:00 AM and 7:00 PM

Primary shift: 10:00 AM-7:00 PM

Standard 8-hour shifts

Overtime may be required only when approved

No direct patient care

Role Overview

We are seeking a Registered Nurse with utilization review or medical review experience to support pre-service, concurrent, and retrospective reviews in a remote environment. This role focuses on ensuring medically appropriate, high-quality, and cost-effective care by applying clinical judgment, regulatory guidelines, and medical necessity criteria.

This position is ideal for an RN who is detail-oriented, highly analytical, and comfortable collaborating with healthcare providers in a non-clinical, administrative setting.

Key Responsibilities

Conduct pre-service, concurrent, and retrospective utilization reviews

Assess medical necessity for outpatient services, out-of-network services, and appropriateness of treatment settings

Collaborate with healthcare providers to promote quality member outcomes and optimize benefit utilization

Ensure care decisions align with clinical guidelines, regulatory standards, and professional scope of practice

Promote effective and efficient use of healthcare resources

Apply Texas Administrative Code (TAC) rules as applicable

Document review decisions clearly and accurately

Support quality, compliance, and cost-containment objectives

Required Skills and Competencies

Strong understanding of medical necessity criteria

Working knowledge of Texas Administrative Code (TAC) regulations

Proficiency with Microsoft Word and Excel

Excellent clinical judgment, analytical thinking, and documentation skills

Ability to work independently in a remote environment

Strong communication skills for provider collaboration

Required Qualifications

Active Registered Nurse (RN) license

Experience conducting utilization review, medical review, or similar non-bedside nursing functions

Ability to work assigned shifts between 7:00 AM and 7:00 PM, with a primary 10:00 AM-7:00 PM schedule

Local residency in or near Austin, TX preferred

Position Highlights

Fully remote role with no direct patient care

Predictable scheduling with defined shift expectations

Opportunity to apply clinical expertise in a regulatory and quality-focused environment

Collaborative role supporting provider alignment and member outcomesCompany Description

Throughout the past 30 years plus, MMC, one of the most trusted names in workforce management services, has successfully delivered strategic solutions to large and small businesses in numerous industries.

We have built our reputation on partnering with our clients and candidates to achieve the desired results. Our recruiting professionals have extensive experience matching the right candidate, to the right client, for the right position. We provide the best opportunities to the most talented candidates in a multitude of industries.

MMC is a privately owned business with corporate headquarters in Irving, Texas. With 2,000+ employees, working in 40+ states, MMC is able to support all United States locations, and some international locations.

We appreciate your interest in reviewing this particular position and we encourage you to visit our website where you can always search and apply for opportunities at

Benefits with MMC Group

MMC offers health insurance plans for our active candidates on assignment, including:

Medical, dental, and vision coverage

Life and disability insurance

Additional voluntary benefits

Join MMC and enjoy the support of a team that values your well-being, both on and off the job.

MMC strives to ensure all job posting confirm details of the position, the rate of pay, and acknowledge medical benefits are offered.

Get started on your career journey today! Apply to become a part of the MMC Team!

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

Fully remote