Utilization Review Nurse- REMOTE- Must be NYS LICENSED
GOOD MORNING & HAPPY TUESDAY!!
EXCITING REMOTE RN OPPORTUNITY!
We are currently seeking an experienced Registered Nurse (RN) for a 100% REMOTE opportunity focused on Utilization Management / Grievance & Appeals!
Pay: $50-55/hour
100% Remote
Schedule: Monday–Friday
Assignment: Temporary
License: Active New York State RN License REQUIRED
Location: You can live outside of New York as long as you hold an active NYS RN license!
WE ARE LOOKING FOR RNs WITH EXPERIENCE IN:
- Utilization Management / Utilization Review
- Prior Authorization
- Managed Care
- Grievance & Appeals
- Case Management
- Medicare & Medicaid
Grievance & Appeals experience is preferred but NOT mandatory!
KEY RESPONSIBILITIES:
- Conduct clinical reviews and determine medical necessity and appropriate levels of care
- Review requests for healthcare services, including prior authorizations and utilization management reviews
- Review clinical documentation using established medical necessity criteria, plan benefits, and regulatory guidelines
- Support Grievance & Appeals reviews involving medical necessity, coverage determinations, and member benefits
- Ensure cases are reviewed within required regulatory and organizational timeframes
- Collaborate with providers, care management teams, medical directors, and internal departments
- Maintain accurate documentation of clinical findings, determinations, and case activity
- Ensure compliance with applicable Medicare, Medicaid, state, and federal regulations
If you are an NYS-licensed RN with strong Utilization Management, Prior Authorization, Managed Care, or Grievance & Appeals experience, I WANT TO HEAR FROM YOU!
Send your resume to: GZIVALI@PHAXIS.COM
Please SHARE or TAG an RN who may be a great fit!
#RegisteredNurse #RNJobs #RemoteRN #RemoteNurse #UtilizationManagement #UtilizationReview #GrievanceAndAppeals #PriorAuthorization #ManagedCare #Medicare #Medicaid #HealthcareJobs #NursingJobs #NowHiring
#PHAXISGONUL
Pay: $50.00 - $55.00 per hour
Expected hours: 35.0 per week
Work Location: Remote