Utilization Review Nurse - 259398
Utilization Review Registered Nurse (RN) – Remote Full-Time | Direct Hire | 100% 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. Compensation & Benefits 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 Weekend Differential: Additional 10% for weekend hours Combined Differential: Up to 20% additional pay for eligible evening/weekend hours Comprehensive benefits package Professional development, continued education, and advancement opportunities Structured training and onboarding Schedule & Work Environment 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
Experience in Utilization Review (UR) or Utilization Management (UM) 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. Interested in learning more? Apply today to connect with a Medix recruiter!