[Hiring] Skilled Nursing Facility Review Nurse @Medix

Role Description

We are seeking an experienced and detail-oriented Licensed Vocational Nurse (LVN) or Registered Nurse (RN) to manage end-to-end Utilization Management (UM) and Discharge Planning. In this role, you will conduct daily inpatient reviews, concurrent reviews, and coordinate care across Skilled Nursing Facilities (SNF), Home Health (HH), and Durable Medical Equipment (DME).

The ideal candidate possesses hands-on expertise navigating MCG criteria, writing formal denial letters, applying Medicare/CMS guidelines, and communicating confidently with Medical Directors and physician partners.

Key Responsibilities

• Manage the complete UM lifecycle through Discharge Planning, conducting daily inpatient concurrent reviews for SNF placements, DME, and Home Health care.
• Apply MCG criteria to evaluate clinical appropriateness, determine care tiers, and write formal, structured denial letters when necessary.
• Utilize Medicare LCD/NCD guidelines and CMS regulations (including the 2-Midnight Rule) for pre-service authorizations and discharge planning.
• Present clear, concise clinical case summaries during daily multidisciplinary rounds. Confidently engage with Medical Directors, attending physicians, and hospital representatives.
• Handle processes involving QIO, NOMNC, and DENC notices.

Qualifications

• Active, unencumbered California RN or LVN License.
• Direct, hands-on Utilization Management (UM) experience in an IPA, MSO, Health Plan, or Delegated model setting. (Inpatient UM experience is required; candidates with only Prior Authorization background will not qualify).
• Proven experience performing SNF initial, concurrent, and discharge reviews.
• True hands-on experience utilizing MCG criteria to drive clinical reviews (not just pull-and-pass).
• Deep familiarity with CMS guidelines (SNF, HH, LCD/NCD) and Medicare discharge standards for SNF and Acute Rehab Units (ARU).
• Proficiency with digital workspace tools, including Microsoft Word, Excel, and PDF workflows. Equipment is provided.

Preferred Qualifications

• 5+ years of concurrent Inpatient Utilization Management experience.
• Strong background in Medicare Advantage or fast-paced Commercial UM environment.
• Knowledge of complex observation vs. inpatient criteria and strict CMS turnaround timelines.

Candidate Attributes for Success

• Highly comfortable presenting complex cases to Medical Directors without hesitation.
• Ability to maintain high accuracy standards (95%+ audit floor) while managing a standard daily caseload of 25-35 cases.
• Excellent organizational and note-taking skills, capable of absorbing complex clinical documentation quickly.
• Dedicated to working uninterrupted at a desktop/laptop environment during standard business hours.

Benefits

• 100% Fully Remote Work: Enjoy working from home anywhere in the United States while serving California healthcare programs.
• Structured Onboarding: A supportive 2-week training program complete with compliance, MCG workflow alignment, case-study practice, and direct nurse shadowing before going live.
• Eligibility for a full employee benefits package during your contract tenure.
• While initial placement is a dedicated contract role covering leave, top-performing contractors frequently gain opportunities for temp-to-perm conversion or transition into permanent clinical teams.