Remote Utilization Review Nurse Specialist

Medix™; Texas; Teletrabalho; USD 67 000 - 91 000; Tempo integral

Resumo da oferta

Medix is seeking a highly skilled Utilization Review Nurse Specialist for a fully remote role in the United States. The RN will assess medical necessity and level-of-care decisions, collaborating with physicians and payers to ensure appropriate care and revenue integrity.

Experienced RNs with ICU/ED/OR background, strong clinical judgment, and a mindset that embraces AI tools to streamline workflows are encouraged to apply.

Qualificações

• Current unrestricted RN license is required; RN Compact license preferred.
• Hands-on nursing experience in ICU, ED, or OR.
• Working knowledge of quality improvement processes.
• Remote setup with reliable high-speed internet and remote work capability.

Responsabilidades

• Evaluate care appropriateness and medical necessity; review levels of care.
• Manage denial prevention, appeals, and P2P coordination with physicians and payers.
• Submit documentation to carriers and FCC with timely, accurate records.
• Educate stakeholders and maintain multidisciplinary collaboration for patient outcomes.

Conhecimentos

RN license

ICU/ED/OR

Quality improvement

Remote work

Clinical judgment

Communication skills

Customer service

Time management

Autonomy

AI mindset

Travel readiness

Ferramentas

InterQual

Descrição da oferta de emprego

Medix is seeking a highly skilled Utilization Review Nurse Specialist for a fully remote role in the United States. The RN will assess medical necessity and level-of-care decisions, collaborating with physicians and payers to ensure appropriate care and revenue integrity.

Experienced RNs with ICU/ED/OR background, strong clinical judgment, and a mindset that embraces AI tools to streamline workflows are encouraged to apply.