Utilization Review RN (Healthcare Revenue Cycle)

Location: Remote nationwide within the United States; candidates must reside in and be authorized to work in the United States. Travel to and work onsite at client, temporary, or corporate office locations may be required as business needs require.

Salary: $63,100–$94,650 annually, depending on experience, education, certifications, and qualifications.

Company

hirify.global provides technology-enabled revenue cycle management solutions and end-to-end revenue cycle services for health systems, hospitals, and affiliated physician groups.

What you will do

• Conduct admission, continued-stay, inpatient, and observation medical necessity reviews using approved clinical criteria.
• Identify over- and under-utilization, barriers to patient progress, and appropriate care resources.
• Coordinate physician advisor referrals, peer-to-peer processes, denials, appeals, and denial trend monitoring.
• Collaborate with care managers, physicians, financial clearance, patient access, payors, and revenue cycle teams.
• Document reviews, communications, work queues, statistical data, and second-level physician review outcomes.
• Support quality improvement, revenue integrity, patient care facilitation, and departmental process improvement.

Requirements

• Bachelor’s degree or equivalent experience in nursing or a related field.
• Current unrestricted RN license required; a compact RN license is preferred or must be obtained.
• Three years of nursing experience in an acute care environment is preferred.
• Strong clinical assessment, organization, problem-solving, communication, negotiation, and prioritization skills.
• High-speed internet access and the ability to work independently in a remote environment.
• Must reside in and be authorized to work within the United States.

Nice to have

• NICU, PICU, pediatric acute care, pediatric specialty care, or related neonatal, infant, and pediatric experience.
• Utilization review or discharge planning experience.
• Working knowledge of medical necessity review criteria and quality improvement processes.

Culture & Benefits

• Full-time 4x10 schedule with four 10-hour shifts per week and every other weekend in rotation.
• Available shifts are 10:00 a.m.–8:00 p.m. and 12:00 p.m.–10:00 p.m.
• 10% weekend differential and 10% shift differential for the later shift; eligible differentials may compound to 20%.
• Comprehensive healthcare, time off, retirement, and well-being benefits.
• Paid professional certifications, tuition reimbursement, career advancement, and incentive programs.
• Remote work with required availability for meetings and training onsite or online.