Medix™
Utilization Management Nurse - 252773
Company Description
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.
Job Description
Now Hiring: Utilization Management Specialist (RN) Remote | Contract Opportunity (6 Months) with potential for hire We’re looking for a skilled Utilization Management Specialist (UMS) to join our growing team! This is a 6-month contract opportunity, open to candidates nationwide, making it a great fit for experienced RNs seeking impactful work. About the Role: The Utilization Management Specialist plays a critical role in determining appropriate levels of care using clinical criteria, Medicare guidelines, and payer requirements. This position partners closely with physicians, case management, revenue integrity, and payers to support accurate admissions, reduce denials, and ensure compliance. Schedule Monday–Friday: 8:00 AM – 4:30 PM EST (flexible start times available) Weekend rotation: Ideally every 3rd weekend (flexible options available) Additional Details: This is a 6-month contract role with potential hire If converted to permanent employment, eligibility is limited to candidates residing in: AZ, CT, FL, MA, ME, MD, MI, NJ, NH, NC, OH, PA, RI, TX, WI
Requirements
Active RN license Graduate of an accredited nursing program (BSN preferred) 2+ years of utilization review with a hospital syste Strong knowledge of payer guidelines, medical necessity criteria, and utilization management practices Ability to work independently and collaborate across interdisciplinary teams Excellent communication and critical thinking skills
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Responsibilities
Review admissions for appropriate patient status and authorization compliance Apply clinical criteria and Medicare Inpatient Only List to determine medical necessity Collaborate with physicians, APPs, and case managers to recommend appropriate level of care Manage payer interactions, including denials and peer-to-peer (P2P) reviews Document clinical findings and authorization details in the medical record Partner with Revenue Integrity and Denials teams to support accurate billing and appeals Conduct admission, continued stay, and discharge reviews Identify trends and support quality improvement initiatives
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