Utilization Review RN (Remote) - 259319

Medix™; United States; Remote; USD 63.000 - 94.000; Vollzeit

Benefits dieser Stelle

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

Zusammenfassung

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

Qualifikationen

• 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.

Aufgaben

• 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.

Ausbildung

Bachelor’s Degree in Nursing

Current RN license

Compact RN license preferred

Jobbeschreibung

Remote Utilization Review Registered Nurse (UR RN)

Are you an experienced RN looking to transition away from the bedside while still making a massive impact on patient care? We are seeking a dedicated Utilization Review Nurse to join our remote team. In this role, you will act as a vital bridge between clinical care and hospital operations, ensuring patients receive the right level of care while safeguarding revenue integrity.

With a compressed 4-day work week, remote flexibility, and highly lucrative shift differentials, this role is designed for nursing professionals who value both operational excellence and a genuine work-life balance.

Compensation, Benefits & Schedule

We believe in rewarding our team for their hard work and flexibility.

• Salary Range: $63,000 - $94,000 annually (dependent upon experience, education, certifications, and overall qualifications).
• The Schedule: Enjoy three days off a week! This role features a 4x10 schedule (four 10-hour shifts per week). You will work every other weekend on a rotating basis.
• Shift Options: 10:00 a.m. - 8:00 p.m. OR 12:00 p.m. - 10:00 p.m. (Candidates must be flexible to work either shift based on business needs).
• 10% Weekend Differential for any hours worked on a weekend.
• 10% Evening Differential for hours worked during the 12:00 p.m. - 10:00 p.m. shift.
• Bonus: These differentials compound! If you work the 12:00 p.m. - 10:00 p.m. shift on a weekend, you can earn a 20% premium on your base pay for those eligible hours.
• Total Rewards: Bonus incentives, Paid Certifications, Tuition Reimbursement, Comprehensive Health Benefits, and clear pathways for Career Advancement.

What You Will Do

• Medical Necessity & Clinical Review: Utilize approved clinical criteria to determine the medical necessity of all admissions, ensuring appropriate patient status and continued stay reviews.
• Resource Utilization: Identify proactive triggers (diagnoses, cost criteria, complications) to monitor the over/under-utilization of healthcare services, and initiate timely physician advisor referrals.
• Denial Management & Appeals: Coordinate the Peer-to-Peer (P2P) process with physicians and Revenue Cycle teams. Monitor denial trends, record updates, and maintain robust documentation to minimize denial rates.
• Revenue Integrity & Quality: Accurately manage ConnectCare and ADT work queues, record statistical data, and help achieve outcomes management goals, including CMS indicators.
• Collaborative Communication: Partner daily with in-house care managers, the Financial Clearance Center (FCC), patient access, and business offices to resolve billing issues related to third-party payers.
• Process Innovation: Actively participate in process improvement initiatives, remaining inquisitive and open to utilizing new technologies (including AI) to streamline workflows and improve the patient/client experience.

What You Bring to the Team

• Education & Licensure: Bachelor’s Degree in Nursing (or equivalent experience). Must hold a current, unrestricted RN license. A current compact RN license is highly preferred, or you must be willing to obtain one.
• Experience: At least 3 years of nursing experience in an acute care environment is strongly preferred. Previous experience in utilization review, discharge planning, or working with medical necessity criteria is highly desired.
• Skills: Exceptional clinical assessment, problem-solving, and organizational skills. You must be able to confidently negotiate and communicate with physicians, payers, and multidisciplinary healthcare teams.
• Remote Work Readiness: This is a remote role requiring reliable high-speed internet and the ability to maintain professional, prompt communication via VoIP, Skype, email, and designated devices.
• Flexibility: While primarily remote, candidates must be willing and able to travel to work onsite at client or corporate office locations occasionally, as business needs require.