(REMOTE) Utilization Review, Registered Nurse (RN) | Job ID: 242999

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.

Schedule: Monday–Friday, 8:00 AM – 5:00 PM Pay Rate: $45–$50/hour (based on experience) Overview: We are seeking an experienced and detail-oriented Registered Nurse (RN) to support prior authorization requests and medication management education in a remote capacity. This role focuses on optimizing medication safety, streamlining access to care, and supporting positive health outcomes—especially for patients managing chronic conditions such as diabetes.

Oversee patients’ medication needs from initial review through post-treatment follow-up. Conduct thorough medication reconciliations, identify drug-related issues, and escalate safety concerns when necessary. Coordinate with pharmacy teams and Pharmacy Benefit Managers (PBMs) to track adverse drug events and ensure proper reporting and follow-through. Support the prior authorization process for medications requiring pre-approval by collaborating with prescribers and payers. Assist in preparing and submitting appeals for denied medications, providing necessary clinical documentation and supporting the patient’s case. Educate patients on medication usage, potential side effects, administration, and recovery timelines. Serve as a liaison among patients, providers, pharmacists, and internal teams to ensure clear, timely communication and care coordination. Collaborate with utilization management and clinical operations teams to inform workflows, technology use, and policy development. Accurately document all assessments, interventions, and communications in accordance with regulatory and payer standards. Track medication utilization and adherence metrics; analyze trends to identify areas for process improvement. Partner with analytics teams to develop medication-related reports and dashboards.