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

<p><strong>Utilization Review (UR) Specialist – RN, LPN, or JD (Remote)</strong></p><p><br></p><p><strong>About Kelly Government Solutions</strong></p><p>At Kelly Government Solutions, we connect top-tier healthcare and legal professionals with impactful career opportunities. We are seeking a detail-oriented <strong>Utilization Review (UR) Specialist</strong> for a premier, full-time <strong>Contract-to-Hire</strong> position. Enjoy the stability of a major employer alongside the flexibility of working from home.</p><p><br></p><p>Why You’ll Love This Role</p><ul><li><strong>100% Remote</strong>: Work comfortably from your home office anywhere in the U.S.</li><li><strong>Career Growth</strong>: A clear contract-to-hire path offers a direct route to permanent employment.</li><li><strong>Utilize Your Credentials</strong>: A great way for clinicians to transition away from the bedside or for JDs to utilize their analytical skills in healthcare.</li></ul><p><br></p><p>Position Overview</p><p>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.</p><p><br></p><p>Key Responsibilities</p><ul><li><strong>Case Management</strong>: Process UR and IRO cases from initial intake through final determination.</li><li><strong>Quality Assurance</strong>: Review clinician determinations for accuracy and alignment with guidelines.</li><li><strong>Documentation</strong>: Draft clear, concise, and professional decision letters and summaries.</li><li><strong>Collaboration</strong>: Partner with clinicians, case managers, and regulatory clients.</li><li><strong>Compliance</strong>: Meet strict turnaround times and regulatory deadlines.</li></ul><p><br></p><p>Work Schedule & Environment</p><p><strong> </strong></p><p><strong>Status</strong>: Full-time hours (Contract-to-Hire).</p><p><strong>Location</strong>: 100% Remote.</p><p><strong>Flexibility</strong>: Requires independent, self-directed work.</p><p><strong>Availability</strong>: Evening and weekend hours are required <em>as needed</em> to meet regulatory deadlines.</p><p><br></p><p><strong>Qualifications:</strong></p><ul><li>Bachelor’s degree in healthcare administration, nursing, public health, or a related field or equivalent combination of education and relevant work experience</li><li>Clinical licensure (e.g., RN, LVN/LPN, or similar) or Juris Doctor (JD) preferred</li><li>Strong analytical and critical thinking skills, particularly in reviewing clinical determinations</li><li>Excellent written communication skills with a high level of clarity and professionalism</li><li>Exceptional attention to detail and organizational skills</li><li>Ability to manage multiple cases and deadlines in a remote work environment</li><li>Familiarity with utilization review, appeals processes, and IRO workflows</li><li>Working knowledge of healthcare regulations and compliance standards</li></ul><p><br></p><p><strong>Required Experience:</strong></p><ul><li>Background in healthcare appeals, utilization review, case management, or related expertise</li><li>Experience reviewing clinical documentation for quality and completeness</li><li>Experience with Medicaid Long-Term Support Services preferred</li></ul><p><br></p><p>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.</p><p><br></p><p>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 <strong>Recruitment Artificial Intelligence Notice</strong>.</p>

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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