You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Company Information

Our client company is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups.

Job Summary

Our client is seeking dedicated and detail-oriented Utilization Review Nurses to join their growing Virtual Utilization Review (VUR) team. In this role, you will conduct medical necessity reviews, evaluate appropriate levels of care, manage denials, and collaborate closely with interdisciplinary teams to ensure optimal clinical resource utilization. This position offers high-impact clinical work in a tech-forward, supportive environment.

Key Responsibilities

• Medical Necessity Determination: Conduct initial and continued stay clinical reviews for inpatient and observation cases using approved clinical review criteria (e.g., MCG). Communicate outcomes to care management and revenue cycle teams.
• Resource Utilization: Utilize proactive triggers to identify potential over- or under-utilization of healthcare services and initiate physician advisor referrals when necessary.
• Denial & Appeals Management: Coordinate Peer-to-Peer (P2P) reviews, assist in documenting denial updates, track overturned days, and monitor denial trends to minimize reimbursement loss.
• Quality & Revenue Integrity: Maintain work queues within EHR systems (Epic/ConnectCare), ensuring documentation is accurate, audit-ready, and compliant with regulatory standards.
• Cross-Functional Collaboration: Communicate effectively with physicians, hospital care managers, financial clearance, and third-party payers to resolve level-of-care discrepancies.
• Innovation & AI Workflows: Embrace new technologies, including AI-augmented workflows and automated EHR systems, to streamline case review processes.

Qualifications

• A dedicated, secure, high-speed home internet workspace.
• Familiarity with commercial payer requirements, Medicare/Medicaid regulations, MS-DRGs, and status determination guidelines.

Experience

• Direct experience in utilization review, discharge planning, or clinical denial management.
• Strong clinical backgrounds in Critical Care (ICU/ER) or specialized NICU / Pediatric hospital settings.

Skills

• Strong clinical assessment, critical thinking, and prioritization skills.
• High proficiency with EHR systems (Epic preferred), medical necessity criteria (MCG), and a willingness to work within AI-augmented workflows.
• Effective communication skills.

Education

• Bachelor’s Degree in Nursing (BSN) or equivalent experience.
• Active, unrestricted RN license required. Compact RN license strongly preferred (single-state license reimbursement available).

Additional Requirements

• This role features a 4x10 schedule (four 10-hour days per week), giving you an extra day off each week.
• Primary Shift: 12:00 PM – 10:00 PM local client time (eligible for premium shift differentials).
• Weekend rotation (every other weekend).

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Medix is an equal opportunity employer and does not discriminate in employment on the basis of political affiliation, race, color, religion, sex, national origin, citizenship, marital status, disability, age, sexual orientation, genetic information, or veteran status in accordance with all applicable federal, state, and local laws.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

^*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.