Utilization Review Nurse
$34 - $40 per hourMedix
Get AI-powered advice on this job and more exclusive features. This range is provided by Medix. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $34.00/hr - $40.00/hr Remote (Compact Licensure Required) - Open to LPN's & RN's About the Role Medix is seeking an experienced Utilization Review Nurse to support our mission of improving patient care through home-based health services. In this role, you will coordinate and review patient authorizations, ensure compliance with Medicare and CMS guidelines, and collaborate with providers, payers, and internal teams to deliver high-quality, cost-effective care. What You’ll Do Process prior authorization and reauthorization requests in line with company policy. Review provider documentation to determine medical necessity for continued care in accordance with Medicare guidelines . Refer cases outside established guidelines to the Utilization Review Physician Advisor. Maintain accurate records of all authorizations and communications with providers and payers. Partner with provider staff to identify patient needs, coordinate services, and support efficient use of healthcare resources . Monitor patient progress and outcomes while ensuring compliance with CMS Chapter 7 and Milliman/MCG guidelines . Provide feedback to clinicians on medical necessity, homebound status, and documentation requirements. Participate in quality review processes, including QPUC/Utilization Review Committee assessments. Rotate coverage for periodic weekends/holidays to support after-hours patient needs. What We’re Looking For Graduate of an accredited nursing program (RN, LPN, or LVN). 2+ years of nursing experience (medical, surgical, or critical care). 1+ year in utilization review/management with home health reviews. Proficiency with EMR/utilization platforms ( InterQual, MCG, Tempo preferred). Knowledge of home health, managed care, NCQA/URAC standards, and community resources. Strong organizational, communication, and time management skills. Ability to work independently in a remote environment . Nice to Have Experience with home care regulations and federal compliance requirements. Advanced proficiency with MS Office Suite and Adobe. Flexibility, self-direction, and the ability to thrive in a fast-paced setting. Why Join ? We believe in supporting both our patients and our people. You’ll find a collaborative, inclusive culture where innovation and growth are encouraged. We offer: Competitive pay and benefits 401(k) matching + equity options Opportunities to make a real impact in home-based healthcare Schedule Apply today to join a team that’s reshaping home health care through compassion, innovation, and excellence. Seniority level Seniority level Associate Employment type Employment type Full-time Job function Job function Other Industries Staffing and Recruiting Referrals increase your chances of interviewing at Medix by 2x Inferred from the description for this job Medical insurance Vision insurance Disability insurance Paid paternity leave Paid maternity leave 401(k) Get notified about new Utilization Review Nurse jobs in United States . United States $65,000.00-$85,000.00 1 day ago Clinical Review Nurse - Prior Authorization Florida, United States $26.50-$47.59 1 day ago Telehealth Registered Nurse- REMOTE September 2025 REMOTE Registered Nurse (IDD Assessments) North Carolina, United States $65,000.00-$78,000.00 2 weeks ago Nurse Reviewer- Registered Nurse (Remote) Florida, United States $65,000.00-$75,000.00 1 week ago Remote Registered Nurse (RN) Case Manager New York, United States $90,000.00-$100,000.00 2 months ago Remote Registered Nurse (RN) Case Manager Remote Registered Nurse (RN) Case Manager United States $80,000.00-$95,000.00 1 week ago Remote Registered Nurse (RN) Case Manager Remote Registered Nurse (RN) Case Manager Remote Registered Nurse (RN) Case Manager United States $69,627.00-$83,888.00 2 weeks ago New York, United States $80,000.00-$100,000.00 2 months ago Remote Registered Nurse (RN) Case Manager New York, United States $26.50-$47.59 1 day ago Utilization Review RN - Remote (Arizona Residents Only) North Carolina, United States $35.00-$40.00 1 day ago Virtual Registered Nurse, Perinatal Health Team Level I & II Remote Registered Nurse (RN) Case Manager We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr
$35 - $45 per hour
...Base pay range $35.00/hr - $45.00/hr Direct message the job poster from IntePros IntePros is seeking a Remote Utilization Review Nurse serves as a key clinical liaison, coordinating resources and services to meet patients’ needs while ensuring compliance with federal,...SuggestedContract workRemote workWeekend workIntePros
New York, NY5 days ago- ...A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and collaborating with teams to meet...SuggestedContract workRemote work
IntePros
New York, NY5 days ago $30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...SuggestedHourly payPart timeRemote workSanta Barbara Cottage Hospital
New York, NY5 days ago$18k
...healing ministry within the communities we serve. Our doctors, nurses, and allied health professionals are a regular self-contained... ..., performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of resources...SuggestedFull timePart timeLive outSanta Barbara Cottage Hospital
New York, NY5 days ago$30 - $38 per hour
...lives. Learn even more about the work that drives us at personifyhealth.com. Responsibilities Job Summary We are seeking Utilization Review Nurse RN to join our team on a part‑time basis, working a minimum of 28 hours per week. The Utilization Review Nurse will provide...SuggestedHourly payFull timePart timeWork at officeRemote workMonday to FridayWeekend workSanta Barbara Cottage Hospital
New York, NY5 days ago- ...A leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services. Responsibilities include processing authorization requests, ensuring compliance with Medicare guidelines, and collaborating with...Remote work
Medix
New York, NY5 days ago - ...Currently seeking a Utilization Management RN . Please see details and qualifications below... ...Must have an active PA license or a Nurse Licensure Compact to include PA. ** Minimum... ...conditions through medical record review to determine medical necessity for services...Immediate startRemote workDay shift
The Judge Group, LLC
New York, NY3 days ago $35 - $43 per hour
...Base pay range $35.00/hr - $43.00/hr Job Title Clinical Review Nurse – Concurrent Review Location: Remote (California only – must reside... ...The Clinical Review Nurse – Concurrent Review will perform utilization management functions to ensure members receive the right care...Remote workIMCS Group
New York, NY5 days ago- What We’re Looking For The ideal Registered Nurse is a versatile and client-focused professional who thrives in a fast-paced wellness environment. You combine strong clinical expertise with a passion for customer service, ensuring each client receives safe, effective,...Full timePart time
- ...difference in the lives of residents every day. At Sunrise Senior Living, we champion the quality of life for all seniors. As a Wellness Nurse (RN), you oversee resident health, support clinical systems and ensure high-quality, compliant care delivery. What You’ll Do: •...Part timeShift work
$64.13 per hour
...nonjudgmental abortion services. When you join PPGNY as a Registered Nurse (RN), you will provide direct clinical care across a full... ...RESPONSIBILITIES SRH Clinical Care and ICA Patient Care (90%) · Reviews the patient health history for completeness and records findings...Full timeTemporary workWork at officeFlexible hours- ...supportive workplace for our team members. \n At Sunrise Senior Living, we champion the quality of life for all seniors. As a Wellness Nurse (RN), you oversee resident health, support clinical systems and ensure high-quality, compliant care delivery. What You’ll Do: •...
New York, NY - Sunrise at East 56th
New York, NY8 days ago - ...every day. Works Under The Supervision Of The Nurse Manager/Clinical Coordinator. The Registered... ...For Customer Service, Teamwork, Resource Utilization, And Staff And Self Development As Outlined In Performance Review. # Performs Other Duties As Assigned Or Directed...
Yale New Haven Hospital
New York, NY4 hours ago $50 per hour
...exceptional compassion and innovation, to enhance the lives of each individual. We offer quality of life. We seek home infusion field nurses (RNs) with experience in various infusion therapies, venous access, and phlebotomy for cases throughout the Bronx, Westchester, and...Hourly payDaily paidFull timePart timeWork at officeLocal area10 hours per weekFlexible hours$41.73 - $65 per hour
...regulatory and Organization policy requirements. Provides direct nursing care pre, during and post procedure, under the direction of the... ...Manager, Director of Nursing and/or Charge Registered Nurse, utilizing standard nursing techniques to assist the physician in optimum...Hourly payDaily paidWork experience placementWork at officeLocal areaImmediate start- ...every day. Works Under The Supervision Of The Nurse Manager/Clinical Coordinator. The Registered... ...For Customer Service, Teamwork, Resource Utilization, And Staff And Self Development As Outlined In Performance Review. # Performs Other Duties As Assigned Or Directed...
Yale New Haven Hospital
New York, NY4 hours ago - ...the lives of residents every day. At Sunrise Senior Living, we champion the quality of life for all seniors. As an LPN Medication Nurse, you provide licensed nursing support through safe medication administration, health monitoring, and accurate clinical documentation...Full timeShift work
- ...day.\n \n \nWorks Under The Supervision Of The Nurse Manager/Clinical Coordinator. The Registered... ...Expectations For Customer Service, Teamwork, Resource Utilization, And Staff And Self Development As Outlined In Performance Review. \n Performs Other Duties As Assigned Or...
Yale New Haven Health
New York, NY11 days ago - ...regulations Current BLS (AHA/ARC) and ACLS (AHA/ARC) certifications Preferred Qualifications: Critical Care Registered Nurse (CCRN) certification TNCC, NIHSS certification Other certifications or licenses may be required for this position Summary:...Temporary work
- A nurse practitioner (NP) as described in Title VIII, Article 139 section 6910 of the New York Education Law is a RN who has earned a separate certification as an NP through advanced clinical nursing education in a distinct specialty area of practice. Nurse practitioners...Full timeTraineeshipLocal area
$2,412 per week
...Prime Staffing is seeking a travel nurse RN Med Surg / Telemetry for a travel nursing job in New York, New York. Job Description... ...perfect fit for both our clients and candidates. Prime Staffing utilizes a unique matchmaking approach, providing the most qualified contingent...Permanent employmentFull timeContract workTemporary workFor contractorsShift workNight shiftDay shiftPrime Staffing
New York, NY1 day ago$2,380 per week
...Prime Staffing is seeking a travel nurse RN Med Surg for a travel nursing job in New York... ..., Purposeful Hourly Rounding, Medication Review, Discharge Wrap Up, and MD/RN Unit... ...institutional chain of command protocol.9. Utilizes institutional information technology by documenting...Hourly payDaily paidPermanent employmentContract workTemporary workFor contractorsZero hours contractLocal areaShift workWeekend workPrime Staffing
New York, NY1 day ago$2,979 per week
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New York, NY2 days ago$58 - $65 per hour
Job Description: The Registered Nurse (RN) is a professional caregiver who assumes responsibility... ...care of patients. The staff RN utilizes the nursing process by use of technology,... ...and national travel RN rates Pay rates are reviewed quarterly and adjusted based on market...Hourly payPrice workFull timeLocal areaShift work- ...Job Description: Are you an experienced home care nurse or are you a dedicated hospital nurse looking for a change? Are you a new... ...balance with the freedom to manage their own schedules. Utilize professional autonomy - You will have all the independence you...Work at officeLocal areaFlexible hours
Americare
New York, NY3 days ago - ...FOR A FUTURE OPENING STGi is currently seeking a Registered Nurse to provide services at our Community Based Outpatient Clinic.... ...signs, symptoms, and complaints) through interviewing patients and reviewing records. ~ Prepare patients for examination and assist the...For subcontractorWork at officeLocal area
STG International
New York, NY2 days ago $52 per hour
...Registered Nurse (RN) Location: Manhattan, NY Hours/Days: 4/10 hour shifts, Mon, Tues, Thurs, Fri 8:00am-6:00pm, RDO Wednesday... ...reaching Knowledge of standard precautions and the ability to utilize appropriate PPE when administering cytotoxic agents and handling...Hourly payTemporary workDay shiftNew York Cancer & Blood Specialists
New York, NY5 days ago- ...Psych RN - , New YorkRegistered Nurse (RN) | contract Healthcare OpportunityISO Workforce Alliance is seeking an experienced Registered Nurse (RN) for an exciting opportunity in , New York. This position offers healthcare professionals the ability to work in a collaborative...Contract workFlexible hours
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New York, NY5 days ago - ...Clinical Nurse The Clinical Nurse is a Registered Professional Nurse who provides safe... ...and informal peer and institutional review processes. Collaborates with interdisciplinary... ...to ensure supplies are appropriately utilized and inventory is sufficient for patient care...Temporary workLocal area
Cynet Health
New York, NY2 days ago $78.64 - $123.2 per hour
...them out of the crowded hospital system so they can heal and age where they are most comfortable- in their homes and community. Our nurses provide the Future of Care by meeting patients where they are. We design and deliver individualized care plans and exceptional...Daily paidRelocation packageFlexible hoursVNS Health
New York, NY4 days ago
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