Remote Utilization Review Nurse: Medicare & Home Health

Medix™; United States; Remote; USD 34,000 - 40,000; Full time

Benefits offered by this job

Competitive pay and benefits

401(k) matching

Opportunities for impactful work

Job summary

A leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services. Responsibilities include processing authorization requests, ensuring compliance with Medicare guidelines, and collaborating with healthcare teams. Qualifications include an accredited nursing degree and experience in utilization review. Competitive pay and remote flexibility offered.

Qualifications

• 2+ years of nursing experience required.
• 1+ year in utilization review/management with home health required.
• Knowledge of home health and managed care standards.

Responsibilities

• Process prior authorization and reauthorization requests.
• Review provider documentation for medical necessity.
• Monitor patient progress and outcomes.

Skills

Organizational skills

Communication skills

Time management

Nursing experience (medical, surgical, or critical care)

Proficiency with EMR/utilization platforms

Education

Graduate of an accredited nursing program (RN, LPN, or LVN)

Tools

InterQual

MCG

Tempo

MS Office Suite

Adobe

Job description

A leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services. Responsibilities include processing authorization requests, ensuring compliance with Medicare guidelines, and collaborating with healthcare teams. Qualifications include an accredited nursing degree and experience in utilization review. Competitive pay and remote flexibility offered.