Utilization Management Review Nurse

Location: Remote Ohio; 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 and health insurance company serving members through insurance and healthcare services, including Medicare and Medicaid populations.

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.
• Communicate with providers, members, and other parties to facilitate optimal care and treatment.
• Apply independent critical thinking and make decisions with minimal direction.
• Follow established utilization management guidelines and organizational procedures.

Requirements

• Active Ohio Registered Nurse (RN) license with no disciplinary action is required.
• At least three years of Medical-Surgical, heart, lung, or critical care nursing experience.
• Previous utilization management experience.
• Clinical experience in an acute care, skilled, or rehabilitation setting is preferred.
• Ability to work 40 scheduled hours per week.
• A dedicated, interruption-free workspace is required to protect member PHI and HIPAA information; home internet must provide at least 25 Mbps download and 10 Mbps upload speeds.

Nice to have

• Bachelor’s degree.
• Three or more years of experience in a high-volume community or mail-order pharmacy practice environment.
• Health plan experience.
• Medicare or Medicaid experience.
• Call center or triage experience.
• Bilingual communication skills.

Culture & Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short-term and long-term disability coverage and life insurance.
• Remote work arrangement with occasional office travel for training or meetings.
• Patient-facing role covered by hirify.global’s tuberculosis screening program; TB screening is required if selected.