Utilization Review Nurse (Remote - AZ / FL / GA / TX)

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients. Job Summary Our client is seeking a Utilization Review Nurse to perform frequent case reviews, check medical records, and communicate with care providers regarding treatment as needed. The nurse will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

Key Responsibilities

• Perform frequent case reviews.
• Check medical records.
• Communicate with care providers regarding treatment as needed.
• Make informed recommendations on care appropriateness based on research results.

Qualifications

• Active, unrestricted RN licensure from the United States in the respective state or active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
• Associate Degree or Bachelors Degree in Nursing or a graduate of an accredited school of nursing.
• Experience with MCG or InterQual tools.
• Ability to obtain additional state licenses to meet business needs.

Experience

• 1+ year of utilization review experience in a managed care setting.
• 1+ years of clinical experience including at least 1 year of clinical practice in an acute care setting such as ER or hospital.

Skills

• Proficiency with MCG or InterQual tools.
• Strong communication skills.
• Ability to work both independently and as part of a team.

Additional Requirements

• Ability to work a flexible schedule, including 4 x 10s as an option, 8-5 this timezone for 5 days a week, including 1 weekend day (either Saturday or Sunday).
• Training schedule : M-F 8 : 30-5pm, usually lasting 6-8 weeks.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans : 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1 / 1, 4 / 1, 7 / 1, and 10 / 1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

• All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.
• Medix is an equal opportunity employer and all my employees are responsible for maintaining a discrimination-free work environment.
• We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview : With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

• This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
• We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
• As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to : accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient's residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

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