Remote Utilization Management RN - SNF/MLTC Specialist

Medix Staffing Solutions, Inc.; New York (NY); A distancia; USD 70.000 - 110.000; Jornada completa

Descripción de la vacante

Medix Staffing Solutions, Inc. is seeking an experienced Utilization Management Registered Nurse (UM RN) for a 100% remote role. Must reside in New York, New Jersey, or Connecticut and hold an active New York RN license.

The position emphasizes SNF, MLTC, Medicare guidelines, and payor communications. Responsibilities include conducting prospective, concurrent, and retrospective reviews, ensuring medical necessity, and collaborating with interdisciplinary teams to optimize discharge planning and

Formación

• Active, unrestricted New York RN license.
• Residence in NY, NJ, or CT is required.
• BSN preferred or equivalent clinical experience.
• Minimum 3+ years of clinical nursing experience, preferably in SNF/MLTC/utilization management.
• Direct Medicare/MLTC knowledge and experience with SNF care levels.
• Ability to perform chart reviews and maintain precise documentation.

Responsabilidades

• Conduct prospective, concurrent, and retrospective utilization reviews for SNF residents.
• Apply Medicare/MLTC guidelines to ensure appropriate level of care.
• Collaborate with physicians, nurses, social workers, and case managers.
• Communicate with payers about authorizations and determinations.
• Support discharge planning, transitions, and appeals when needed.
• Maintain compliant, timely documentation per regulatory standards.

Conocimientos

RN License

Residency NY NJ CT

Clinical Nursing Experience

Medicare/MLTC Knowledge

Chart Review & Documentation

Remote Work Capability

Interdisciplinary Collaboration

Educación

BSN Preferred or equivalent experience

Herramientas

EMR Systems

Utilization Management Platforms

Descripción del empleo

Medix Staffing Solutions, Inc. is seeking an experienced Utilization Management Registered Nurse (UM RN) for a 100% remote role. Must reside in New York, New Jersey, or Connecticut and hold an active New York RN license.

The position emphasizes SNF, MLTC, Medicare guidelines, and payor communications. Responsibilities include conducting prospective, concurrent, and retrospective reviews, ensuring medical necessity, and collaborating with interdisciplinary teams to optimize discharge planning and