Utilization Review (UR) Specialist – RN, LPN, or JD (Remote)

About Kelly Government Solutions
At Kelly Government Solutions, we connect top-tier healthcare and legal professionals with impactful career opportunities. We are seeking a detail-oriented Utilization Review (UR) Specialist for a premier, full-time Contract-to-Hire position. Enjoy the stability of a major employer alongside the flexibility of working from home. 

Why You’ll Love This Role

• 100% Remote: Work comfortably from your home office anywhere in the U.S.
  

• Career Growth: A clear contract-to-hire path offers a direct route to permanent employment.
  

• Utilize Your Credentials: A great way for clinicians to transition away from the bedside or for JDs to utilize their analytical skills in healthcare.

Position Overview
As a UR Specialist, you will manage the full lifecycle of Independent Review Organization (IRO) and Utilization Review (UR) appeals from start to finish. You will use your analytical expertise to ensure clinical determinations are accurate, complete, and fully compliant with regulatory standards.  

Key Responsibilities

• Case Management: Process UR and IRO cases from initial intake through final determination.
  

• Quality Assurance: Review clinician determinations for accuracy and alignment with guidelines.
  

• Documentation: Draft clear, concise, and professional decision letters and summaries.
  

• Collaboration: Partner with clinicians, case managers, and regulatory clients.
  

• Compliance: Meet strict turnaround times and regulatory deadlines.

Work Schedule & Environment

• Status: Full-time hours (Contract-to-Hire).
  

• Location: 100% Remote.
  

• Flexibility: Requires independent, self-directed work.
  

• Availability: Evening and weekend hours are required as needed to meet regulatory deadlines.

Qualifications:

• Bachelor’s degree in healthcare administration, nursing, public health, or a related field or equivalent combination of education and relevant work experience
  

• Clinical licensure (e.g., RN, LVN/LPN, or similar) or Juris Doctor (JD) preferred
  

• Strong analytical and critical thinking skills, particularly in reviewing clinical determinations
  

• Excellent written communication skills with a high level of clarity and professionalism
  

• Exceptional attention to detail and organizational skills
  

• Ability to manage multiple cases and deadlines in a remote work environment
  

• Familiarity with utilization review, appeals processes, and IRO workflows
  

• Working knowledge of healthcare regulations and compliance standards

Required Experience:

• Background in healthcare appeals, utilization review, case management, or related expertise
  

• Experience reviewing clinical documentation for quality and completeness
  

• Experience with Medicaid Long-Term Support Services preferred

Kelly is committed to providing equal employment opportunities to all qualified employees and applicants regardless of race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or any other legally protected status, and we take affirmative action to recruit, employ, and advance qualified individuals with disabilities and protected veterans in the workforce. Requests for accommodation related to our application process can be directed to the Kelly Human Resource Knowledge Center. Kelly complies with the requirements of California’s state and local Fair Chance laws. A conviction does not automatically bar individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

Kelly may use AI-powered tools during the recruitment and hiring process. For full details, including how Kelly uses AI, your rights, and how to request a reasonable accommodation, visit the Recruitment Artificial Intelligence Notice.

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