Utilization Review Clinician (Healthcare)

Location: Remote - US; applicants must be legally authorized to work in the United States. Travel of up to 30% may be required based on business needs.

Company

hirify.global develops healthcare technology and services that support care delivery, medical management, and improved health outcomes.

What you will do

• Conduct prior authorization and continued-stay reviews for post-acute care services using clinical guidelines and coverage criteria.
• Determine medical necessity, benefits, and appropriate levels of care in accordance with health plan guidelines and contractual requirements.
• Collaborate with case managers, physicians, medical directors, facilities, and other stakeholders to coordinate care and transitions.
• Escalate cases to medical directors, peer reviewers, or delegated clinical reviewers when needed.
• Support payer programs, compliance with federal and state standards, review consistency, and process improvement initiatives.

Requirements

• Bachelor's degree or equivalent work experience.
• 4–6 years of clinical nursing or therapy experience.
• Active RN, OT, or PT license.
• Working knowledge of Microsoft Office applications, including Word and Excel.
• Legal authorization to work in the United States is required; employment eligibility will be verified at hire.
• Ability to work additional or irregular hours when needed and view a computer screen for extended periods.

Nice to have

• 1–2 years of experience in utilization review, case management, or managed care regulations.
• Experience with MCG Guidelines, InterQual, or other clinical decision support tools used in utilization management and prior authorization.

Culture & Benefits

• Collaborative and inclusive environment focused on innovation and independent thinking.
• Medical, prescription, dental, and vision benefits for eligible full-time employees.
• Mental health support through an employee assistance program.
• Generous paid time off and 13 paid holidays.
• Fully vested 401(k) retirement plans and educational assistance of up to $2,500 per year.