Remote Utilization Review RN: Care & Compliance Leader

Medix™; Ohio; Remote; USD 70,000 - 95,000; Full time

Benefits offered by this job

Remote work

Competitive pay

Shift differentials

Professional growth

Job summary

Medix™ is seeking an experienced Registered Nurse (RN) to join our Utilization Review team in a remote capacity. The role evaluates medical necessity, reviews levels of care, and supports denial prevention and appeals across the continuum of care.

The ideal candidate will collaborate with physicians, care managers, and payers to promote appropriate resource utilization and regulatory compliance, while delivering high-quality patient outcomes.

Qualifications

• Current, unrestricted RN license (compact RN license preferred).
• Clinical background in critical care settings or acute care.
• Strong communication and collaboration with physicians, payers, and care teams.
• Ability to handle complex cases with clinical judgment and compliance.

Responsibilities

• Conduct admission, continued-stay, and observation reviews to evaluate medical necessity and levels of care.
• Identify overutilization or barriers to patient progression and address gaps.
• Submit clinical documentation to insurance carriers within one business day of admission.
• Coordinate physician advisor referrals and second-level reviews with care teams.
• Support denial management, appeals, and revenue integrity with accurate documentation.

Skills

Clinical assessment

Critical-thinking

Problem-solving

Communication skills

Organizational skills

Independent work

Customer service

Education

RN license

Compact RN license preferred

Tools

InterQual

Job description

Medix™ is seeking an experienced Registered Nurse (RN) to join our Utilization Review team in a remote capacity. The role evaluates medical necessity, reviews levels of care, and supports denial prevention and appeals across the continuum of care.

The ideal candidate will collaborate with physicians, care managers, and payers to promote appropriate resource utilization and regulatory compliance, while delivering high-quality patient outcomes.