Direct message the job poster from Medix™
Job Type: Full-Time | 6-Week Project (with potential to extend)
Location: Remote – U.S. based
Schedule: Monday–Friday, Daytime Hours
Why Join Us?
- 100% Remote Work – Enjoy the flexibility of working from home
- Supportive and Collaborative Team Environment
- Make a Meaningful Impact on Patient Care and Health Outcomes
- Opportunity to gain experience with a respected organization
About the Role
We are seeking an experienced and detail‑oriented Utilization Review Nurse (RN) for a 6‑week project supporting clinical reviews and care management decisions.
There is a strong possibility of extension based on project needs and performance .
In this role, you will evaluate the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities under the provisions of applicable health plans.
Key Responsibilities
- Conduct utilization reviews for inpatient, outpatient, and specialty services
- Assess clinical documentation to determine medical necessity and appropriate level of care
- Communicate effectively with providers, healthcare teams, and insurance payers
- Accurately document findings using internal systems and adhere to review timelines
- Ensure compliance with clinical guidelines and regulatory standards
Qualifications
- Active and unrestricted RN license (compact license preferred)
- At least 2 years of utilization review or case management experience
- Familiarity with InterQual or MCG guidelines
- Knowledge of CMS, NCQA, and/or URAC standards
- Self‑motivated with strong clinical judgment and attention to detail
- Reliable internet and remote work setup
Preferred Qualifications
- Certification in Case Management (CCM) or Utilization Review (CPUR, CHCQM)
- Experience with commercial, Medicare, or Medicaid health plans
- Competitive hourly rate
- Weekly pay
- Possibility for project extension
- Fully remote work environment
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