Utilization Management Nurse (Medicare Appeals)

Location: Remote nationwide within the United States; occasional travel to hirify.global offices for training or meetings may be required. Weekend coverage is required every Saturday and Sunday, with flexible weekday scheduling and a required holiday rotation.

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

Company

hirify.global is a U.S. healthcare and insurance company serving Medicare, Medicaid, individual, family, military, and community populations.

What you will do

• Prepare Medicare and Duals expedited, pre-service, and post-service grievance and appeal cases for medical director review.
• Review medical documentation, claims, benefits, coverage guidelines, and prior determinations.
• Write structured summaries of case findings using established templates.
• Collaborate with hirify.global CIT teams, vendors, grievance and appeal specialists, and medical directors.
• Oversee weekend workflow, monitor appeal inventory, prioritize assignments, and escalate operational risks.
• Provide real-time guidance to associates and support process improvement, operational efficiency, and member outcomes.

Requirements

• Associate's degree.
• Active Registered Nurse license with a compact license in the appropriate state and no disciplinary action.
• At least 3 years of clinical experience, preferably in acute care, skilled nursing, rehabilitation, or a broad clinical nursing setting.
• Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
• Ability to work independently under general instructions and collaborate effectively with a team.
• Dedicated home workspace and internet service with at least 25 Mbps download and 10 Mbps upload speeds are required.

Nice to have

• BSN or bachelor's degree in a related field.
• Grievance and appeal review experience.
• Experience with MHK, Medicare or Medicaid, utilization management, or claims.
• Leadership experience.

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- and long-term disability coverage and life insurance.
• Work-from-home arrangement supporting focused handling of member PHI and HIPAA-protected information.