---
title: 'Utilization Review Nurse (RN) at Evry Health'
canonical: 'https://feeny.ai/job/utilization-review-nurse-rn-evry-health-remote-0gpcgbgsc68n'
type: 'job'
last_seen: '2026-09-07'
---

# Utilization Review Nurse (RN) at Evry Health

- **Company:** Evry Health
- **Location:** Remote
- **Employment:** full-time
- **Work type:** remote
- **Posted:** 2026-09-01
- **Last confirmed live:** 2026-09-07
- **Apply:** https://jobs.lever.co/evry-health/461fe452-832c-4f16-81ac-028be5aa8e17

## Job description

Position Summary:

The RN Integrated Care Coordinator (UM) provides comprehensive care coordination services and is responsible for quality outcomes for members across the care continuum using a variety of data sources. This role is critical to the operation of our Clinical Team and the overall experience of Evry Health’s members. The incumbent strives to ensure a positive member experience and builds solid relationships with members, providers, and facilities to ensure Evry Health is a reliable and trusted parter in member care. Rotating weekend hours are required to address utilization review cases.

Roles and Responsibilities

- Prepares clinical reviews based on clinical guidelines and provides monitoring of cases involving medical decisions and quality of care or service decisions. Presents recommendations based on clinical review, criteria, and organizational policies to physician reviewers for final determination.
- Conducts prior authorization, concurrent, and retrospective reviews with emphasis on utilization management, discharge planning, care coordination, clinical outcomes, and quality of care by applying MCG guidelines, medical policy, and benefit structure for defined service requests.
- Monitors clinical quality concerns, make referrals appropriately, identify and escalate care quality issues, and quickly identifies outlier cases, long length of stay cases or complicated prior authorization requests.
- Ability to interact with external facility or providers as needed to gather clinical information to support the medical necessity review process and plan of care.
- Assists departmental staff with issues related to coding, medical records/documentation, pre-certification, reimbursement, and claim denials/appeals.
- Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement.
- Effectively assess and facilitate appropriate utilization of clinical programs and/or discharge planning by thoroughly assessing and screening for proper care coordination following discharge.
- Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure.
- Ability to assist and facilitate working relationship with Medical Director on CM and UM cases.
- Demonstrates personal responsibility and accountability by meeting attendance and schedule adherence expectations with positivity, enthusiasm, and helpful personality.
- Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins, efficiently answering and documenting member/provider calls.

## Experience and Skills Desired

- Previous healthcare/managed care appeals experience.
- Must have a current, unrestricted Texas nursing license or Compact License. Please include your license number(s) and the corresponding state(s) in your resume.
- Diploma from an accredited school/college of nursing required.
- You have 1-2 years of experience working at a health plan performing utilization management using standard practice guidelines.
- You have working knowledge of medical and insurance industry terminology including basic level CPT/ICD10, authorizations, digital health programs, NCQA/URAC standards.
- You have 3-5 years of clinical experience in a hospital or ambulatory setting assisting with direct patient care.
- You have a passion for quality, teamwork, problem solving, and critical thinking.
- You can work independently and comfortable in a fast-paced, deadline-oriented, tech savy, work environment.
- You have an area of interest or experience within cardiology/pulmonology, women’s health, orthopedic surgery/physical medicine, primary care/pediatrics, and oncology.
- You have experience outreaching and educating members telephonically.
- You have an innovative and entrepreneurial spirit with a passion to contribute to a much-needed change in our health care system.
- Bonus: Familiarity with Salesforce/Healthcloud/CareIQ.
- Bonus: CCM or ACM certification, MCG certification
- Bonus: Appeals experience

Telecommuting Requirements

- This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas.
- Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reside in the CST or EST time zones. This position requires work during the stated business hours as well as rotating on-call weekends for utilization review cases.
- Required to have a dedicated work area established that is separate from other living areas and provides information privacy.
- Ability to keep all company sensitive documents secure.
- Must live in a location that receives an existing high-speed internet connection/service.

## Benefits Package

- Competitive salary
- Comprehensive health, dental, and vision insurance as well as life and disability
- Retirement savings plan with company match
- Generous time off/vacation
- Professional development opportunities
- Flexible and remote work environment

## About Evry Health

## Company Overview
- **One-liner**: Evry Health provides health insurance solutions for mid-sized businesses, aiming to lower premiums by 20% while improving care quality.
- **Entity Type**: Private (Acquired by Globe Life in October 2023)
- **Headquarters**: Dallas, Texas, United States
- **Founded**: 2017
- **Founders**: Chris Gay (CEO), Jay Startz (COO), Mark Jamilkowski (Chief Actuary)

## Core Business
- **Primary industry**: Health Insurance (Insurtech)
- **Target customers**: B2B – mid-sized companies (employer-sponsored health plans)
- **Mission or purpose**: "Better health insurance for mid-size companies that costs 20% less and provides more effective medical care." [ycombinator.com](https://www.ycombinator.com/companies/evry-health)

## Products & Services
- **EPO (Exclusive Provider Organization)**: A large group fully insured health plan designed for mobile workforces, including virtual care, pre-authorization, and notifications/admissions. [cbinsights.com](https://www.cbinsights.com/company/evry-health)
- **Virtual Care Program**: Partnerships (e.g., Color Health) to expand access to virtual cancer care and other telehealth services.
- **Member App & Portal**: Integrated application for members to manage claims, find providers, and access care.

## Market Standing
- **Valuation/Market Cap**: Not disclosed (acquired by Globe Life, terms not public)
- **Key Metric**: Annual Revenue of $5M (as of latest data) [linkedin.com](https://linkedin.com/company/evryhealth)
- **Total Funding**: $7.5M (Seed round led by Y Combinator in 2018, Venture round in 2021) [linkedin.com](https://linkedin.com/company/evryhealth)
- **Notable Investors/Partners**: Y Combinator (Winter 2018 batch), Globe Life (acquirer), Color Health (partner)
- **Growth Signals**: 85% YoY headcount growth (44 employees), 7 active job postings, 600% quarterly increase in job postings. [linkedin.com](https://linkedin.com/company/evryhealth)

## Competitive Advantages
- **Founder expertise**: CEO Chris Gay previously founded MileMeter Insurance (invented per-mile auto insurance) and built a full P&C insurance software stack.
- **Y Combinator backing**: Early validation and network from a top accelerator.
- **Post-acquisition stability**: Backed by Globe Life (a major insurance group) provides resources and market access.
- **Differentiated model**: Focus on lowering costs 20% while improving outcomes through integrated virtual care and data-driven underwriting.

## Strategic Focus
- **Post-acquisition integration**: Merging into Globe Life’s portfolio while maintaining brand and tech stack.
- **Expanding virtual care**: Partnerships like Color Health to enhance cancer care and other specialty services.
- **Technology investment**: Modern tech stack (React, Node, Azure, Kubernetes, OpenAI, etc.) to automate claims, underwriting, and member experience.
- **Talent acquisition**: Actively hiring for engineering, AI, underwriting, and medical director roles to scale operations.

## Why Work Here
- **Remote-first culture**: Many roles (e.g., Sr. Software Engineer, Commercial Underwriter) are fully remote. [jobs.lever.co](https://jobs.lever.co/evry-health)
- **Competitive benefits**: Health insurance, 401(k) matching, flexible vacation. [evryhealth.com](https://www.evryhealth.com/careers)
- **Growth opportunity**: Rapidly scaling team (85% YoY headcount increase) with roles across engineering, AI, and healthcare operations.
- **Engineering culture**: Modern stack (React, Node, TypeScript, Azure, Kubernetes, GraphQL, PostgreSQL, Redis, OpenAI) and emphasis on AI solutions.
- **Mission-driven**: Opportunity to directly improve healthcare affordability and quality for mid-size businesses.

## Sources
1. [linkedin.com](https://linkedin.com/company/evryhealth)
2. [cbinsights.com](https://www.cbinsights.com/company/evry-health)
3. [ycombinator.com](https://www.ycombinator.com/companies/evry-health)
4. [evryhealth.com](https://www.evryhealth.com/careers)
5. [jobs.lever.co](https://jobs.lever.co/evry-health)

## Other roles at Evry Health

- [Senior Software Engineer (Node)](https://feeny.ai/job/senior-software-engineer-node-evry-health-remote-4c45pv4aen7w)
- [Commercial Health Underwriter - Remote](https://feeny.ai/job/commercial-health-underwriter-remote-evry-health-remote-p566w8gzwzjs)
- [Director of Regulatory Compliance- Large Group Health Insurance](https://feeny.ai/job/director-of-regulatory-compliance-large-group-health-insurance-evry-health-9cxw51m6epbt)