Utilization Review Nurse

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