Utilization Management Nurse (Healthcare)

Location: Remote Florida; must reside in the state of Florida. Monday–Friday, 8-hour shift between 8:30 AM and 5:30 PM local time. Occasional travel to hirify.global offices for training or meetings may be required.

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

Company

hirify.global is a U.S. healthcare company providing insurance and healthcare services to Medicare, Medicaid, military, individual, and community members.

What you will do

• Coordinate, document, and communicate medical services and benefit administration determinations.
• Interpret clinical criteria, policies, and procedures to determine appropriate treatment, care, and services.
• Coordinate with providers, members, and other parties to facilitate optimal care and treatment.
• Review utilization management and prior authorization requests.
• Make independent decisions in varied and occasionally ambiguous situations while following established guidelines.

Requirements

• Licensed Registered Nurse with at least 3 years of clinical experience in acute care, skilled nursing, long-term care, or rehabilitation; or Licensed Practical Nurse with at least 5 years of relevant clinical experience.
• Active Florida license with no disciplinary action.
• Residence in the state of Florida is required.
• Ability to work 40 hours per week on the required local-time schedule.
• Dedicated, interruption-free workspace and home internet with at least 25 Mbps download and 10 Mbps upload speeds to protect member PHI and HIPAA information.

Nice to have

• BSN or bachelor’s degree in a related field.
• Utilization management, utilization review, or prior authorization experience.
• Case management experience with Long-Term Services and Supports members.
• Experience with MCG guidelines and durable medical equipment requests.
• Familiarity with health plan operations.

Culture & Benefits

• Remote work with occasional office travel for training or meetings.
• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short- and long-term disability coverage, life insurance, and wellness-focused benefits.