Utilization Review (UR) Specialist - RN, LPN, JD

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.

About the role

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.

Responsibilities

• Process UR and IRO cases from initial intake through final determination.
• Review clinician determinations for accuracy and alignment with guidelines.
• Draft clear, concise, and professional decision letters and summaries.
• Partner with clinicians, case managers, and regulatory clients.
• Meet strict turnaround times and regulatory deadlines.

Requirements

• 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.
• 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.

Qualifications

• 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.

Schedule

• Full-time hours (Contract-to-Hire).
• 100% Remote.
• Requires independent, self-directed work.
• Evening and weekend hours are required as needed to meet regulatory deadlines.

Benefits

• Voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, and a legal plan.
• Retirement savings plan.
• Service bonus and holiday pay plans (earn up to eight paid holidays per benefit year).
• Transit spending account.
• Paid sick leave under the applicable state or local plan.