REMOTE Utilization Management RN - 456782
Medix™
About the role
Registered Nurse – Clinical Review Specialist
100% Remote | Full-Time
Job Summary
We are seeking an experienced Registered Nurse (RN) to join a fully remote clinical review team. In this role, you will conduct frequent case reviews, evaluate medical records, communicate with healthcare providers regarding treatment when needed, and make recommendations regarding the appropriateness of care based on clinical research and established guidelines.
This is an excellent opportunity for a clinically experienced RN who is interested in transitioning from bedside nursing into a non-bedside clinical review role while continuing to use their nursing expertise.
Key Responsibilities
- Perform detailed clinical case reviews and evaluate patient medical records.
- Assess treatment plans and services for identified diagnoses.
- Conduct research related to medical conditions and treatment appropriateness.
- Communicate with physicians and other healthcare providers regarding patient care as needed.
- Make clinical recommendations based on medical records, research, and established clinical guidelines.
- Document findings and recommendations accurately and thoroughly.
- Adapt to new clinical review processes, technology, and workflows.
Required Qualifications
- Active, unrestricted RN license in state of residence OR an active compact multistate RN license (NLC) .
- Must be willing and able to obtain additional state licenses based on business needs.
- ADN, BSN, or nursing diploma from an accredited nursing program.
- Minimum 3+ years of bedside or clinical nursing experience .
- Preferred clinical backgrounds include:
- Emergency Department (ED)
- Intensive Care Unit (ICU)
- Medical-Surgical (Med Surg)
- Skilled Nursing Facility (SNF)
- Rehabilitation
- Strong computer and technology skills with the ability to learn new systems quickly.
- Comfortable working extensively on a MacBook/Apple platform .
- Strong communication, critical thinking, and clinical judgment skills.
- Adaptable, motivated, and eager to learn a new area of nursing.
- Must have a quiet, dedicated, HIPAA-compliant home office environment .
Preferred Qualifications
- Strong MacBook/Apple knowledge and experience.
- Experience with clinical documentation review, utilization management, care management, or similar clinical review functions is a plus.
Schedule
Full-Time | 40 hours per week
Flexible scheduling options include:
- 4 x 10-hour shifts , or
- 5 x 8-hour shifts , typically 8:00 AM–5:00 PM in your assigned time zone.
- Schedule will include one weekend day each week.
Available schedule options may include:
- Sunday–Wednesday
- Tuesday–Saturday
Training Schedule
Training is typically 6–8 weeks and will be conducted:
Monday–Friday | 8:30 AM–5:00 PM in your assigned time zone
Location
100% Remote
Candidates must reside in one of the following states:
AL, AZ, AR, CO, CT, DC, FL, GA, ID, IL, IN, IA, KS, KY, ME, MD, MA, MI, MN, MS, MO, NE, NV, NH, NJ, NM, NY, NC, OH, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WI
Why Join?
- 100% remote opportunity
- Great opportunity to transition from bedside nursing into a clinical review role
- Use your nursing expertise through medical record review and clinical research
- Flexible 4x10 or 5x8 scheduling options
- Work in a technology-driven healthcare environment
- Opportunity to learn a new discipline and expand your clinical career
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