Utilization Review Nurse - 258847

Medix™; California; Remote; USD 55,000 - 70,000; Part time

Job summary

Medix Staffing Solutions, Inc. is seeking an experienced California RN or LVN with strong Utilization Management and inpatient review experience for a 100% remote role focused on inpatient clinical review, UM, and discharge planning.

You will apply MCG criteria and Medicare guidelines, coordinate SNF/ARU placements, participate in multidisciplinary rounds, and collaborate with Medical Directors and hospital teams while maintaining a California license.

Qualifications

• Active California RN or LVN license.
• Strong utilization management and inpatient review experience.
• Experience applying MCG criteria and Medicare guidelines.
• Remote work capability and ability to collaborate with hospital teams.

Responsibilities

• Manage the full UM process through discharge planning.
• Apply MCG criteria to clinical reviews.
• Apply LCD/NCD and Medicare guidelines.
• Coordinate complex SNF and ARU placements.
• Participate in multidisciplinary rounds.
• Collaborate with Medical Directors, physicians and hospital teams.

Skills

Utilization management

Inpatient reviews

Multidisciplinary rounds

CMS turnaround timelines

Education

California RN or LVN license

Job description

Looking for an experienced California RN or LVN with strong Utilization Management and inpatient review experience?

We’re hiring for a 100% REMOTE opportunity focused on inpatient clinical review, utilization management, and complex discharge planning.

Pay: $40–$50.48/hr, based on experience & licensure

Contract: Temporary contract with potential to convert based on business needs & performance

What you’ll do:

• Manage the full UM process through discharge planning
• Apply MCG criteria to clinical reviews
• Apply LCD/NCD and Medicare guidelines
• Coordinate complex SNF and ARU placements
• Participate in multidisciplinary rounds
• Collaborate with Medical Directors, physicians & hospital teams
• Active, unencumbered California RN or LVN license
• Commercial UM background (nurses who possess a fast pace and a sharp sense of urgency).
• Hands-on MCG expertise with inpatient acute/SNF reviews
• Strong background in Medicare Advantage due to strict CMS turnaround timelines and complex observation vs. inpatient criteria.
• Strong background in Medicare Advantage due to strict CMS turnaround timelines and complex observation vs. inpatient criteria.

If you have strong MCG + Medicare/inpatient review experience and are ready to take your UM expertise into a fully remote role,