Utilization Review Nurse - 244996
Medix™
Turn this role into an interview — a resume and cover letter built around what this employer wants.
Benefits offered by this job
Job summary
Qualifications
- 2+ years of nursing experience required.
- 1+ year in utilization review/management with home health required.
- Knowledge of home health and managed care standards.
Responsibilities
- Process prior authorization and reauthorization requests.
- Review provider documentation for medical necessity.
- Monitor patient progress and outcomes.
Skills
Education
Tools
Job description
Get AI-powered advice on this job and more exclusive features.
This range is provided by Medix. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.
$34.00/hr - $40.00/hr
Remote (Compact Licensure Required) - Open to LPN's & RN's
About the Role
Medix is seeking an experienced Utilization Review Nurse to support our mission of improving patient care through home-based health services. In this role, you will coordinate and review patient authorizations, ensure compliance with Medicare and CMS guidelines, and collaborate with providers, payers, and internal teams to deliver high-quality, cost-effective care.
What You’ll Do
- Process prior authorization and reauthorization requests in line with company policy.
- Review provider documentation to determine medical necessity for continued care in accordance with Medicare guidelines.
- Refer cases outside established guidelines to the Utilization Review Physician Advisor.
- Maintain accurate records of all authorizations and communications with providers and payers.
- Partner with provider staff to identify patient needs, coordinate services, and support efficient use of healthcare resources.
- Monitor patient progress and outcomes while ensuring compliance with CMS Chapter 7 and Milliman/MCG guidelines.
- Provide feedback to clinicians on medical necessity, homebound status, and documentation requirements.
- Participate in quality review processes, including QPUC/Utilization Review Committee assessments.
- Rotate coverage for periodic weekends/holidays to support after-hours patient needs.
What We’re Looking For
Graduate of an accredited nursing program (RN, LPN, or LVN).
2+ years of nursing experience (medical, surgical, or critical care).
1+ year in utilization review/management with home health reviews.
Proficiency with EMR/utilization platforms (InterQual, MCG, Tempo preferred).
Knowledge of home health, managed care, NCQA/URAC standards, and community resources.
Strong organizational, communication, and time management skills.
Ability to work independently in a remote environment.
Nice to Have
Experience with home care regulations and federal compliance requirements.
Advanced proficiency with MS Office Suite and Adobe.
Flexibility, self-direction, and the ability to thrive in a fast-paced setting.
Why Join ?
We believe in supporting both our patients and our people. You’ll find a collaborative, inclusive culture where innovation and growth are encouraged. We offer:
- Competitive pay and benefits
- 401(k) matching + equity options
- Opportunities to make a real impact in home-based healthcare
Schedule
Apply today to join a team that’s reshaping home health care through compassion, innovation, and excellence.
- Seniority levelAssociate
- Employment typeFull-time
- Job functionOther
- IndustriesStaffing and Recruiting
Referrals increase your chances of interviewing at Medix by 2x
Medical insurance
Vision insurance
Disability insurance
Paid paternity leave
Paid maternity leave
401(k)
Get notified about new Utilization Review Nurse jobs in United States.
United States $65,000.00-$85,000.00 1 day ago
Florida, United States $26.50-$47.59 1 day ago
North Carolina, United States $65,000.00-$78,000.00 2 weeks ago
Florida, United States $65,000.00-$75,000.00 1 week ago
New York, United States $90,000.00-$100,000.00 2 months ago
United States $80,000.00-$95,000.00 1 week ago
United States $69,627.00-$83,888.00 2 weeks ago
New York, United States $80,000.00-$100,000.00 2 months ago
New York, United States $26.50-$47.59 1 day ago
North Carolina, United States $35.00-$40.00 1 day ago
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
'/%3e%3cpath%20d='M101.744%2012.4726L102.894%2016.1947L99.0021%2013.2201L101.744%2012.4726ZM105.3%208.40937H100.488L99.0026%203.59473L97.5116%208.41047L92.7%208.40385L96.5965%2011.3834L95.1055%2016.1942L99.0021%2013.2196L101.408%2011.3834L105.3%208.40992V8.40937Z'%20fill='white'/%3e%3cdefs%3e%3clinearGradient%20id='paint0_linear_5593_1381'%20x1='90'%20y1='9.44471'%20x2='99'%20y2='9.44471'%20gradientUnits='userSpaceOnUse'%3e%3cstop%20stop-color='%2300AD70'/%3e%3cstop%20offset='0.998594'%20stop-color='%2300B67A'/%3e%3cstop%20offset='1'%20stop-color='%23DCDCE6'/%3e%3c/linearGradient%3e%3c/defs%3e%3c/svg%3e){kind=small}
