Job Description
Title : Utilization Management Nurse - Post Acute
Location : Minnetonka, MN (Remote)
Job Type : Contract (3 Months + Potential to extend and/ or convert after 6 months)
Compensation : $40.00-45.00/hr W2
Industry: Health Insurance
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About the Role We are supporting a leading, nonprofit health insurance organization headquartered in the Midwest in their search for a Utilization Management Nurse specializing in post-acute care. This position plays a key role in ensuring high-quality, cost-effective care by reviewing authorization requests and applying established clinical criteria.
This is an excellent opportunity for an experienced RN with strong clinical judgment and utilization management experience to contribute to an organization dedicated to improving member health outcomes.
Job Description The Utilization Management Nurse – Post Acute is responsible for completing clinical reviews for prior authorization and concurrent stay requests. This includes evaluating medical necessity based on internal policies, industry-standard clinical criteria (MCG), and member coverage guidelines.
In this role, you will collaborate closely with members, providers, facilities, medical directors, intake teams, case managers, and internal departments. The ideal candidate demonstrates strong critical-thinking skills, independent judgment, and the ability to manage complex clinical information with accuracy.
Key Responsibilities: - Review and document prior authorization and concurrent stay requests for post-acute care settings (Skilled Nursing Facility, Acute Inpatient Rehab, LTACH, etc.)
- Apply clinical criteria (MCG) and coverage guidelines to determine medical necessity
- Communicate and collaborate with providers, members, medical directors, and internal teams
- Maintain thorough and accurate documentation in accordance with organizational standards
- Utilize multiple systems and applications to complete reviews and process information
Qualifications Required Qualifications - Associate’s or Bachelor’s degree in Nursing
- Active, unrestricted RN license
- 3–5+ years of clinical experience
- Previous utilization management experience within post-acute settings
- Strong clinical assessment and critical-thinking skills
- Ability to work independently and collaboratively
- High attention to detail and strong organizational skills
- Comfort working within multiple computer applications
- Primary residence located in Minnesota or Wisconsin (required for remote eligibility)
Preferred Qualifications - Experience with MCG guidelines
- Background in payer or managed care environments
- Experience with remote clinical review workflows
Work Arrangement - 100% Remote - candidates must be located in Minnesota or Wisconsin for consideration
- Candidates must maintain a professional remote work environment
- Reliable high-speed internet is required
Internet Speed Requirements: - Minimum download speed: 25+ Mbps
- Minimum upload speed: 5+ Mbps
- Ping: < 100 ms
- All candidates must submit a screenshot of results from: (click “BEGIN TEST”)
Benefits Dahl Consulting is proud to offer a comprehensive benefits package to eligible employees that will allow you to choose the best coverage to meet your family’s needs. For details, please review the DAHL Benefits Summary:
How to Apply Take the first step on your new career path!
To submit yourself for consideration for this role, simply click the apply button and complete our mobile-friendly online application. Once we’ve reviewed your application details, a recruiter will reach out to you with next steps!
Equal Opportunity Statement As an equal opportunity employer, Dahl Consulting welcomes candidates of all backgrounds and experiences to apply. If this position sounds like the right opportunity for you, we encourage you to take the next step and connect with us. We look forward to meeting you!
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Job Tags
Contract work, Remote work