Virtual Utilization Review Supervisor (Healthcare)

Location: Remote nationwide within the United States; applicants must reside in and be authorized to work in the United States.

Salary: $84,000–$126,000 annually, based on experience.

Company

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

What you will do

• Supervise virtual utilization review activities and evaluate medical necessity for admissions, observation stays, and continued care.
• Use clinical review criteria to assess resource utilization, patient status, care barriers, and appropriate care settings.
• Coordinate denial management, payer appeals, denial tracking, readmission monitoring, and related documentation.
• Collaborate with physicians, nurses, hospital liaisons, case management, coding, financial clearance, patient access, and revenue cycle teams.
• Support quality and revenue integrity initiatives, including CMS indicators, work queues, data accuracy, and regulatory compliance.
• Educate clinical and hospital staff while maintaining clear communication and participating in process improvement activities.

Requirements

• Current unrestricted RN license required.
• Residence and authorization to work within the United States required.
• At least 5 years of nursing experience in an acute care environment.
• At least 2 years of utilization review experience and 1 year of leadership or coaching experience.
• Experience with utilization review, discharge planning, medical necessity criteria, clinical assessment, organization, and problem solving.
• Associate degree in Nursing required; bachelor's degree in Nursing preferred. Current MCG certification is required or must be obtained within 6 months of hire.

Culture & Benefits

• Comprehensive healthcare, paid time off, retirement, and well-being benefits.
• Bonus and incentive programs, paid professional certifications, and tuition reimbursement.
• Remote work with an emphasis on collaboration, innovation, leadership, and work-life flexibility.
• Career advancement and professional development opportunities.