Inpatient Utilization Management Nurse (RN/LVN) – 260160

Medix™; California; Remote; USD 90,000 - 120,000; Full time

Job summary

Medix is seeking experienced Registered Nurses (RN) or Licensed Vocational Nurses (LVN) for a 100% remote Utilization Management role in inpatient acute care. Involves discharge planning, concurrent reviews, and post-acute coordination, with a California license required and 5+ years of UM experience preferred.

The position supports a fast-paced, metrics-driven environment and offers a fully remote work arrangement with a contract-to-hire path.

Qualifications

• Active, unrestricted California RN or LVN license.
• 5+ years of concurrent inpatient Utilization Management experience strongly preferred.
• Experience in IPA, MSO, Delegated Medical Group, or Health Plan environments.
• Hands-on experience with MCG Guidelines for inpatient acute care and SNF reviews.
• Experience with discharge planning, denial letter writing, and Medicare guidelines.
• Proficient with Microsoft Office (Excel, Word, PDF).

Responsibilities

• Manage the full Utilization Management process from admission through discharge.
• Perform concurrent inpatient reviews, daily clinical reviews, and discharge planning.
• Coordinate post-acute services including SNF, Home Health, and DME.
• Apply MCG criteria, Medicare guidelines, and medical necessity criteria for reviews.
• Prepare and issue clinical denial letters.
• Present patient cases during rounds and collaborate with physicians and hospital staff.
• Maintain accurate documentation while meeting productivity and quality metrics.

Skills

Clinical judgment

Critical thinking

Communication with physicians

Independent remote work

Productivity focus

Detail-oriented

Tools

Microsoft Office

Job description

100% Remote | Contract-to-Hire | Monday–Friday 8-5pm | California License Required

We are seeking experienced Registered Nurses (RN) or Licensed Vocational Nurses (LVN) with a strong background in Inpatient Utilization Management to join a growing healthcare organization. This is a fully remote opportunity supporting inpatient acute care, discharge planning, and concurrent review in a fast-paced, metrics-driven environment.

Responsibilities

• Manage the full Utilization Management (UM) process from admission through discharge.
• Perform concurrent inpatient reviews, daily clinical reviews, and discharge planning.
• Coordinate post-acute services including Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME).
• Apply MCG criteria, Medicare guidelines (LCD/NCD), and medical necessity criteria for inpatient and pre-service authorization reviews.
• Prepare and issue clinical denial letters.
• Present patient cases during multidisciplinary rounds and collaborate with physicians, Medical Directors, and hospital staff.
• Maintain accurate documentation while meeting productivity and quality metrics.

Required Qualifications

• Active, unrestricted California RN or LVN license.
• 5+ years of concurrent inpatient Utilization Management experience strongly preferred.
• Experience working within an IPA, MSO, Delegated Medical Group, or Health Plan environment.
• Hands-on experience utilizing MCG Guidelines for inpatient acute care and SNF reviews.
• Experience with discharge planning, denial letter writing, and Medicare guidelines.
• Proficient with Microsoft Office (Excel, Word, PDF).

Preferred Qualifications

• Emergency Department nursing experience with Utilization Management or discharge planning exposure.

Schedule

• Monday–Friday
• 8:00 AM – 5:00 PM PST
• Fully Remote

Why Join Us?

• 100% Remote position.
• Comprehensive 2-week paid training program with nurse shadowing and hands-on case review.
• Join a collaborative team with opportunities for long-term growth.

What We're Looking For

• Strong clinical judgment and critical thinking.
• Comfortable communicating with physicians and Medical Directors.
• Ability to thrive in a fast-paced, high-volume environment.
• Detail-oriented, organized, and highly motivated.
• Comfortable working independently in a fully remote setting while meeting productivity goals.