Utilization Management US RN Senior Analyst

About the role

The Utilization Management US RN Senior Analyst supports the Grievance & Appeals team by preparing complete appeal records and detailed case summaries for external review. This role ensures compliance with Independent Review Entity (IRE) standards and delivers timely, accurate information to medical directors and client teams.

Key responsibilities

• Create comprehensive appeal records using standardized IRE forms and attach all required documentation.
• Develop detailed narrative case summaries for each appeal.
• Submit cases to the appropriate geographic region as directed.
• Present verbal and written case summaries to the client’s Grievance Team and Medical Directors.
• Meet client‑designated turnaround times for all assignments.

Required profile

• Bachelor of Science in Nursing (BSN) degree, GNM Diploma, BSC in Nursing, Associate Nursing Degree, or Nursing Diploma.
• Current, unrestricted US Registered Nurse license.
• Minimum 3 months (480 hours) of clinical experience as an RN in an inpatient, outpatient, or community clinic setting.
• At least 6 months of Utilization Management experience for a CL‑10 USRN role.
• Experience in team lead, QA, training, or claims functions is preferred.

Required skills