Utilization Review Nurse

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This range is provided by Medix. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

$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 (Inter Qual, 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 Associate

• Employment type
  
  Full-time

• Job function Other
• Industries Staffing and Recruiting

Referrals increase your chances of interviewing at Medix by 2x

Medical insurance

Vision insurance

Disability insurance

Paid paternity leave

Paid maternity leave

401(k)

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