REMOTE Utilization Management Nurse (Inpatient)

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.

Inpatient Utilization Management Nurse (Concurrent Review) Location: Remote (U.S. Based, Working PST Hours) Position Overview We are seeking an experienced Inpatient Utilization Management (UM) Nurse to perform concurrent review for initial inpatient admissions. This role focuses exclusively on Medicare members and requires strong knowledge of MCG criteria and Medicare/Medicare Advantage processes. The ideal candidate has inpatient UM experience, excellent clinical judgment, and the ability to clearly document, communicate, and advocate in a fast-paced environment. This is a temporary, remote role with the potential to convert to a permanent position after approximately 16 weeks.

Conduct concurrent reviews for inpatient admissions using MCG clinical criteria. Apply sound clinical judgment to synthesize medical records and determine medical necessity. Draft clear and original denial letters (high OBS scrutiny expected). Present cases during weekly rounds with Medical Director, including catastrophic cases (≥10-day LOS or flagged diagnoses). Collaborate with physicians, case managers, and internal teams; escalate when necessary. Maintain accurate, timely documentation in compliance with internal quality standards. Navigate manual workflows (fax reliance at some facilities, limited EMR access).