Sr. Virtual Utilization Review Specialist

Location: Remote - Nationwide, United States. The role may require travel to and work onsite at client, temporary, or corporate office locations as business needs require. The department operates 7 days per week from 8:00 a.m. to 10:00 p.m., including weekends as needed.

Salary: $32.65–$43.90 per hour, based on experience.

Company

hirify.global provides technology-enabled revenue cycle management solutions for health systems, hospitals, and affiliated physician groups across the United States.

What you will do

• Conduct medical necessity reviews for admissions, continued stays, inpatient and observation cases using approved clinical review criteria.
• Identify potential over- or under-utilization, barriers to patient progress, and appropriate levels of care.
• Coordinate physician-to-physician reviews, denial appeals, documentation, and denial trend reporting.
• Collaborate with care managers, physicians, physician advisors, payors, financial clearance, patient access, and revenue cycle teams.
• Maintain accurate records, work queues, statistical data, and communications related to utilization and revenue cycle workflows.
• Educate clinical and hospital staff while supporting patient care, quality indicators, and revenue integrity goals.

Requirements

• Bachelor’s degree or equivalent experience in nursing or a related field.
• Current unrestricted RN or LPN license required; a compact license is required.
• Three years of nursing experience in an acute care environment is preferred.
• Utilization review or discharge planning experience, medical necessity review criteria knowledge, and quality improvement experience are preferred.
• Strong clinical assessment, organization, problem-solving, communication, negotiation, and collaboration skills.
• High-speed internet and the ability to work remotely while traveling to onsite locations when business needs require it.

Nice to have

• Utilization review or discharge planning experience.
• Recent working knowledge of medical necessity review criteria.
• Three years of acute care nursing experience.

Culture & Benefits

• Comprehensive healthcare, time off, retirement, and well-being benefits.
• Paid professional certifications and tuition reimbursement.
• Bonus and quarterly or annual incentive programs.
• Career advancement and professional development opportunities.
• Culture focused on collaboration, innovation, work-life flexibility, and continuous improvement.