Appeals Nurse - 253261

Medix provides workforce solutions to clients and creates opportunity for talent in the Healthcare, Life Sciences, Engineering and Technology fields. Through our core purpose of positively impacting lives, we have earned our reputation as an industry leader by providing unsurpassed customer service and top quality professionals to our clients.

Utilization Management RN – Inpatient Appeals (Remote | Contract) Equipment - need to have their own equipment - Laptop (windows OS) & extra monitor Contract: until Nov 2026 We’re partnering with a growing Medicare Advantage health plan seeking experienced Utilization Management RNs to support inpatient appeals during a period of rapid expansion and increased case volume. This is a high-impact, fast-paced role ideal for nurses who can step in quickly, think critically, and produce strong, defensible clinical determinations with minimal ramp time.

Review inpatient cases at the appeals level (post-denial) Evaluate medical necessity, level of care, and length of stay Apply InterQual and/or MCG (Milliman) criteria Develop clear, defensible clinical rationales (uphold or overturn) Ensure compliance with Medicare Advantage and regulatory guidelines Collaborate on complex or escalated cases Maintain accurate and timely documentation Manage a consistent caseload while meeting productivity expectations