Utilization Review Nurse - 259398

Medix™; Ohio; Remote; USD 63,000 - 90,000; Full time

Benefits offered by this job

Annual bonus

Evening differential

Combined differential

Remote work

4x10 shifts

Job summary

Medix is partnering with a leading national healthcare organization to hire Registered Nurses for a fully remote Utilization Review team. The role offers a base salary of $63,100–$90,000 per year with a 5% target annual bonus and up to 20% combined differential.

The RN will review medical necessity, collaborate with physicians and care teams, and handle documentation while working 4x10 shifts remotely. Open to qualified candidates nationwide, excluding CA, CO, NY.

Qualifications

• Active RN license (unrestricted).
• 3+ years acute-care nursing experience.
• Familiarity with utilization review or inpatient care management preferred.

Responsibilities

• Conduct medical necessity and utilization reviews for inpatient stays and observations.
• Review clinical documentation and diagnoses to assess care appropriateness.
• Apply InterQual/MCG criteria and other guidelines.

Skills

Clinical assessment

Critical thinking

Medical documentation

Communication

Organization

Independent remote work

Education

ADN or BSN

Tools

InterQual/MCG criteria

Job description

Utilization Review Registered Nurse (RN) – Remote

Salary: $63,100–$90,000 annually + Bonus + Shift Differentials

Medix is partnering with a leading national healthcare organization to hire Registered Nurses for a fully remote Utilization Review team!

We are seeking RNs with backgrounds in Utilization Review, Utilization Management, ICU, Emergency Department, Operating Room, or inpatient care management. Prior utilization review experience is highly preferred, but experienced acute-care nurses interested in transitioning into this specialty are also encouraged to apply.

• Base Salary: $63,100–$90,000 annually, depending on experience
• Annual Bonus: 5% target, with potential to exceed target
• Evening Differential: Additional 10% for the eligible evening shift
• Combined Differential: Up to 20% additional pay for eligible evening/weekend hours
• Professional development, continued education, and advancement opportunities
• Structured training and onboarding
• 100% Remote — work from home
• Four 10-hour shifts per week (4x10)
• Available shifts: 10:00 AM–8:00 PM or 12:00 PM–10:00 PM
• Every other weekend required
• Rotating holiday coverage (approximately 2–3 holidays annually, with holiday pay)
• Initial training conducted primarily Monday–Friday during regular business hours, with occasional weekend training possible

Location:

Open to qualified candidates throughout the United States, excluding residents of California, Colorado, and New York. Occasional work-related travel may be required.

Key Responsibilities

• Conduct medical necessity and utilization reviews for inpatient admissions, observation cases, and continued hospital stays.
• Review clinical documentation, patient diagnoses, treatment plans, and medical records to evaluate the appropriateness of care.
• Apply established medical necessity criteria, including InterQual, MCG, or other approved clinical guidelines.
• Collaborate with physicians, care managers, nursing teams, and revenue cycle professionals to support appropriate patient status and treatment decisions.
• Coordinate physician advisor referrals, peer-to-peer reviews, and second-level medical necessity determinations.
• Identify documentation gaps, potential denials, and opportunities to improve resource utilization.
• Maintain accurate and timely clinical documentation while meeting established quality and productivity expectations.
• Support compliance with payer requirements, CMS guidelines, and healthcare regulations.

Required Qualifications

• Active, unrestricted Registered Nurse (RN) license
• Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN)
• Minimum 3 years of acute-care nursing experience
• Strong clinical assessment, critical thinking, and medical documentation skills
• Excellent communication and organizational abilities
• Ability to work independently in a fast-paced, remote environment
• Flexibility to work the required shifts, alternating weekends, and rotating holidays
• Reliable high-speed internet access

Preferred Qualifications

• Clinical background in ICU, Critical Care, Emergency Department, or Operating Room nursing
• Experience with InterQual or MCG clinical review criteria
• Inpatient case management, medical necessity review, or concurrent review experience
• Knowledge of admission status, observation versus inpatient determinations, and continued-stay reviews
• Physician advisor coordination, denials, appeals, or peer-to-peer review experience
• Compact/multistate RN license
• BSN or pediatric nursing experience

Why Consider This Opportunity?

This position offers the opportunity to transition away from traditional bedside care while continuing to apply your clinical expertise to meaningful patient care decisions.

Whether you're an experienced utilization review nurse or an acute-care RN ready for your next professional challenge, this is an opportunity to join an established healthcare organization that values clinical expertise, collaboration, and continued growth.