Utilization Review Nurse
This is the employer's own posting, not a copy on a job board.
What we know
Is it still open?
Confirmed still open
Last checked 2d ago — checked against the employer's own applicant tracking system, which is the company answering directly.
We re-read the employer's own applicant tracking system and the posting was still there. That is the company answering directly.
How old is it?
Posted 13d ago
The date the source published, not the day we noticed it (2026-10-20). Last seen at its source 5h ago.
We have tracked this listing since 20 Oct 2026 (12 days). The employer's own board has carried it every time we have read it, most recently 5 hours ago.
Is it remote?
Marked remote on the employer's board
Their board carries a remote setting on this posting — a field they filled in, not wording we read. The location field names somewhere specific, which is usually where the team or the entity sits.
Who may apply?
United States
The description states no restriction of its own. This is the source's own tag.
Pay not stated
Similar roles pay $96.3k–135k/yr
Middle 50% of 1264 listings that do state pay — Healthcare · all levels · United States · USD/year. This employer has published no salary; this is what comparable listings we hold disclose, never converted between currencies or periods. How this is calculated.
Skills named in the ad
Recognised terms only, from a fixed vocabulary — this is what CV matching compares against.
Carried by 1 source
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Workable employer's own board first seen 12d ago · last seen 5h ago
The listing
Rising Medical Solutions has an opening for a Utilization Review Nurse, and we want to hear from you! We're a bill review and cost containment company - so what does that mean? Basically we are trying to fix a very broken healthcare system by reducing the cost of healthcare claims through bill review, case management, and utilization review. Our mission is "To make lives better" and everyone here at Rising works hard to achieve this goal. So take a look at the job, let us know what you think, and let's start working towards a better future!
**This is a full-time position - 40 hours per week (Must work M-F each day).
Responsibilities
- Perform all aspects of the Utilization Review Process
- Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone
- Utilize evidence-based guidelines to determine if authorization can be given versus having to send the file or for Peer or Physician Review
- Write nurse summaries on all UR files
- Document properly in Rising's database (and client data bases when appropriate), and send determination letters on each completed UR
- Establish collaborative relationships with clients, patients, employers, providers and attorneys
- Track ongoing status of all UR activity so that appropriate turn-around times are met
- Maintain organized files containing clinical documentation of interactions with all parties of every claim
- Utilize good clinical judgment, careful listening, and critical thinking and assessment skills
- Respond to various written and telephonic inquiries regarding status of case
- Must be proficient in the use of a computer, including the use of various software programs simultaneously
Requirements
- An Associate's or Bachelor's degree in Nursing
- Hold an active and unencumbered RN license in one or more states
- 3 to 5 years of clinical practice experience or 2 years of case management and/or UR experience
- More than one state license (a plus)
- Experience with Workers' Compensation, short-term or long-term disability, or liability claims
- The ability to set priorities and work both autonomously and as a team member
- Well-developed time-management, organization, and prioritization skills
- Excellent analytical skills
- Superb oral and written communication
- The ability to gather data, compile information, and prepare summary reports
- Strong interpersonal and conflict resolution skills
- Experience in a fast-paced, multi-faceted environment
- Demonstrated persistence and attention to detail
- General understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines
- Working knowledge of: Microsoft Word, Excel, and Outlook
- Ability to remain calm during stressful situations
- A customer-service mindset
Benefits
- Generous Flexible Time Off (take it when you need it!)
- Comprehensive benefit package including health/dental/vision insurance, profit sharing, and 401k matching
- Career Growth Opportunities - We often promote from within
- Professional Development Reimbursement Program (PDRP)
- You will be part of our new Elevate program designed to recognize and reward employees for their hard work
- Rising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Working at Rising Medical Solutions | Top Workplaces
- We're on YouTube! Check out our culture at: http://www.youtube.com/user/RisingMedical
- Want to see more? Check out our:
If you are ready to join a team of professionals dedicated to making a difference and making lives better, please apply today!