Remote Utilization Review Nurse Specialist

Medix™; Texas; Remote; USD 79,000 - 92,000; Full time

Job summary

Medix™ seeks an experienced Utilization Review Nurse Specialist for a fully remote role in the United States. You will evaluate medical necessity, determine level-of-care decisions, and collaborate with physicians, interdisciplinary teams, and commercial carriers to optimize care and revenue integrity.

Ideal candidates are RNs with ICU/ED/OR background, strong clinical judgment, and a passion for leveraging AI-enabled workflows to streamline processes while upholding HIPAA and high-quality

Qualifications

• Current unrestricted RN license required (RN Compact preferred).
• Hands-on clinical nursing experience in ICU, ED, or OR.
• Strong clinical assessment, critical thinking and problem-solving.
• Remote work setup with reliable high-speed internet.

Responsibilities

• Evaluate medical necessity and level-of-care reviews for admissions and ongoing care.
• Coordinate with physicians, care managers, and payers to ensure appropriate resource use.
• Submit documentation to carriers and maintain appeal and denial workflows.
• Educate stakeholders on utilization review processes and payer requirements.

Skills

RN licensure

ICU/ED/OR experience

Clinical judgment

Remote work setup

Communication skills

Negotiation

Education

Registered Nurse (RN)

Tools

InterQual

AI-enabled workflows

Job description

Medix™ seeks an experienced Utilization Review Nurse Specialist for a fully remote role in the United States. You will evaluate medical necessity, determine level-of-care decisions, and collaborate with physicians, interdisciplinary teams, and commercial carriers to optimize care and revenue integrity.

Ideal candidates are RNs with ICU/ED/OR background, strong clinical judgment, and a passion for leveraging AI-enabled workflows to streamline processes while upholding HIPAA and high-quality