10/02/2026
Our company — UST HealthProof is hiring for:
USRN - Utilization Management and USRN Supervisor (2):
Salary Offer: 75K - 85K + 150K Signing Bonus (1 year bond)
Temporary Work From Home Set-up
WFH equipment provided by our company
Must have both active USRN and PHRN licenses
Must have at least 2 years experience in UM**
Responsibilities:
Perform prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, the intensity of service, and level of care, including appeal requests initiated by providers, facilities, and members
Review, research, and prepare documentation related to retrospective review requests and appeals in accordance with local, state, and federal regulatory and designated accreditation (e.g., NCQA) standards
Contact appropriate medical and support personnel to identify and recommend an alternative treatment, service levels, length of stays, etc. using approved clinical protocols
Follow out-of-area/out-of-network services and make recommendations on patient transfer to in-network services and/or alternative plans of care
May establish care plans and coordinate care through the health care continuum including member outreach assessments
Establish, coordinate, and communicate discharge planning needs with appropriate internal and external entities
Review patterns of care associated with disease progression; identify contractual services and organize delivery through appropriate channels
Research and resolve issues related to benefits, member eligibility, non-elective and non-authorized services, coordination of benefits, care coordination as needed
Develop and deliver targeted education for the provider community related to policies, procedures, benefits when appropriate
Requirements:
Current, unrestricted, mainland USRN license
2-4 years of clinical experience which may include acute patient care, discharge planning, case management, utilization review, etc.
Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes
Medicare Advantage experience preferred
Excellent written and verbal communication skills
Excellent customer service and interpersonal skills
Ability to apply clinical criteria/guidelines for medical necessity, setting/level of care, and concurrent patient management
Knowledge of current standard medical procedures/practices and their application as well as current trends and developments in medicine and nursing, alternative care settings, and levels of service
Knowledge of policies and procedures, member benefits, and community resources
Knowledge of applicable accreditation standards, and local, state, and federal regulations
Skills
Healthcare, Customer Support, Utility Management
To apply, please send your CV to:
HiringUSTBPO@gmail.com 📩⬅️
