Remote Utilization Review RN — Four-Day Week Perks

Medix™; United States; Remote; USD 85,000 - 110,000; Full time

Benefits offered by this job

Remote position

Four 10-hour shifts per week

Weekend differential up to 20%

Job summary

Medix™ is seeking a clinically strong, detail-oriented Registered Nurse to join our Utilization Review team in a fully remote role. You will conduct medical necessity reviews, determine appropriate patient status, and collaborate with physicians and payors to support quality patient care and appropriate resource utilization.

The ideal candidate has acute care experience, strong clinical decision-making abilities, and is comfortable working remotely with reliable internet access.

Qualifications

• Strong clinical assessment skills and familiarity with medical necessity criteria.
• Excellent communication and organizational abilities.
• Ability to work independently in a fast-paced, remote environment.

Responsibilities

• Conduct medical necessity reviews for inpatient admissions, observation stays, and continued stays.
• Apply clinical review criteria to determine patient status and level of care.
• Collaborate with physicians, care managers, and payors to obtain documentation.
• Coordinate peer-to-peer reviews and assist with appeals and denial management.
• Monitor denial trends, quality indicators, and revenue cycle workflows.

Skills

Clinical assessment

Communication

Organization

Problem solving

Independent work

Education

Bachelor's degree in Nursing

Job description

Medix™ is seeking a clinically strong, detail-oriented Registered Nurse to join our Utilization Review team in a fully remote role. You will conduct medical necessity reviews, determine appropriate patient status, and collaborate with physicians and payors to support quality patient care and appropriate resource utilization.

The ideal candidate has acute care experience, strong clinical decision-making abilities, and is comfortable working remotely with reliable internet access.