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

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