Remote Utilization Review RN — Flexible 4x10 Schedule

Medix™; United States; Remote; USD 63,000 - 94,000; Full time

Benefits offered by this job

Weekend differential 10%

Evening differential 10%

20% premium on weekend hours

Paid certifications

Tuition reimbursement

Comprehensive health benefits

Career advancement

Remote work with occasional onsite

Job summary

Medix is seeking a Remote Utilization Review Registered Nurse (UR RN) to bridge clinical care and hospital operations from a remote setting. Join a team optimizing patient care while safeguarding revenue integrity, with a compressed 4-day week, remote flexibility, and lucrative shift differentials.

The role emphasizes medical necessity reviews, utilization monitoring, denial management, and collaboration with care managers and payer teams, alongside ongoing process improvements and AI-enabled

Qualifications

• Bachelor’s Degree in Nursing or equivalent experience.
• Current, unrestricted RN license; compact license preferred or willing to obtain.
• 3+ years nursing experience in acute care; utilization review or discharge planning desirable.

Responsibilities

• Medical Necessity & Clinical Review: Use approved criteria to determine medical necessity of admissions.
• Resource Utilization: Monitor over/under-utilization and initiate physician advisor referrals.
• Denial Management & Appeals: Coordinate P2P with physicians and Revenue Cycle teams; monitor denial trends and documentation.
• Revenue Integrity & Quality: Manage ConnectCare and ADT work queues; support CMS indicators.
• Collaborative Communication: Partner with care managers, FCC, patient access, and business offices to resolve billing issues.
• Process Innovation: Participate in process improvements, open to AI tools to streamline workflows.

Education

Bachelor’s Degree in Nursing

Current RN license

Compact RN license preferred

Job description

Medix is seeking a Remote Utilization Review Registered Nurse (UR RN) to bridge clinical care and hospital operations from a remote setting. Join a team optimizing patient care while safeguarding revenue integrity, with a compressed 4-day week, remote flexibility, and lucrative shift differentials.

The role emphasizes medical necessity reviews, utilization monitoring, denial management, and collaboration with care managers and payer teams, alongside ongoing process improvements and AI-enabled