Utilization Management Nurse

Location: Remote, but must reside and perform work in Louisiana, United States. Occasional travel to hirify.global offices for training or meetings may be required. Schedule: Monday through Friday, 8:00 AM to 5:00 PM Central Time; overtime and weekend rotations may be requested.

Salary: $71,100–$97,800 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare and health insurance company serving members through Medicare, Medicaid, and other healthcare services.

What you will do

• Coordinate, document, and communicate medical service and benefit administration determinations.
• Interpret clinical criteria, policies, and procedures to support appropriate treatment and care decisions.
• Communicate with providers, members, and other parties to facilitate optimal care.
• Support the Medicaid care management team and report to the Manager of Care Management.
• Make independent decisions within established guidelines and procedures, including in ambiguous situations.

Requirements

• Active Louisiana Registered Nurse license with no disciplinary action; ability to obtain licenses in multiple states.
• At least 3 years of varied RN nursing experience.
• Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
• Ability to work independently and collaboratively with minimal direction.
• Must reside and conduct work in Louisiana.
• Must be available for a 40-hour work week during Monday–Friday business hours, with possible overtime and weekend rotation.

Nice to have

• BSN or bachelor's degree in a related field.
• Utilization management review or prior authorization experience.
• Health plan and Medicare/Medicaid experience.
• Experience with MCG guidelines.
• Compact nursing license.

Culture & Benefits

• Remote work from home with a dedicated workspace required to protect member PHI and HIPAA information.
• Home internet must provide at least 25 Mbps download and 10 Mbps upload speeds.
• Telephone equipment is provided for business needs.
• Four-to-six-week training program with sessions from 8:00 AM to 5:00 PM, plus additional virtual training opportunities.
• Benefits include medical, dental and vision coverage, 401(k), paid time off, holidays, parental and caregiver leave, disability coverage, and life insurance.