Remote Utilization Review Nurse - AI Tools

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

Job summary

Medix is seeking a registered nurse for Utilization Review (UR) on a remote, full-time basis. The role involves medical necessity and level-of-care reviews across all ages, with a 4x10 schedule and every-other-weekend requirement. Evening hours from 12:00 PM to 10:00 PM receive a 10% differential.

The position requires ICU/ED/OR clinical experience, strong quality-improvement skills, and flexibility to travel occasionally to corporate/client sites.

Qualifications

• Active, unrestricted RN license (Compact RN preferred).
• Direct clinical experience in ICU, ED, or OR.
• Knowledge of quality improvement processes.

Responsibilities

• Perform medical necessity and level-of-care reviews across age groups.
• Detect and address over- and under-utilization and patient care barriers.
• Submit clinical documentation to carriers and FCC within 1 business day of admission.
• Coordinate physician advisor referrals and reviews.
• Collaborate with revenue cycle teams to resolve billing issues and denial trends.
• Train staff on UR processes, regulatory updates, and payer rules.
• Adhere to FCC communication guidelines across channels.
• Adopt new technologies to streamline workflows.

Skills

Clinical judgment

Payer negotiation

Time management

AI/tech tools

Education

RN license

Tools

Remote setup

Job description

Medix is seeking a registered nurse for Utilization Review (UR) on a remote, full-time basis. The role involves medical necessity and level-of-care reviews across all ages, with a 4x10 schedule and every-other-weekend requirement. Evening hours from 12:00 PM to 10:00 PM receive a 10% differential.

The position requires ICU/ED/OR clinical experience, strong quality-improvement skills, and flexibility to travel occasionally to corporate/client sites.