Get Hired Faster With COMPANY_NAME!
Don't you ever think you landed here by any accident, You are here because you are searching for something bigger. You know what?
- A better Job
- A better Future
- A better Knowledge
- A better Paycheck
- A greater Path to walk on.
And COMPANY_NAME is here to give you exactly what you've been missing for so long. The reality is that most job seekers chase job postings, but successful job seekers attract job offers by chasing the accurate information. Therefore, that's the shift COMPANY_NAME is going to help you make. Here are the top 10 ideas to up-skill yourself, so lean in to begin:
1: COMPANY_NAME Smart Tools and Direct Employer Connections Help Speed Up Your Hiring Process
COMPANY_NAME is a career-changing advantage that most seekers never get access to. Imagine...
- Instead of applying for job after job and still not getting any callbacks, you suddenly bump into a tool that can do the heavy lifting for you.
- Instead of wondering, "What do employers actually want?", you are getting insights straight from the employer's desk.
- Instead of hoping your resume gets noticed, it’s kept on the table of decision-makers who are hiring right now.
That's the difference COMPANY_NAME makes. Our tools will let you reach employers directly, which automatically speeds up your hiring process.
2: With Better Matches, Real-time Job Alerts, and Direct Employer Responses, COMPANY_NAME Helps Many Candidates Secure Interviews and Job Offers Within 15 to 30 Days!
How does COMPANY_NAME make this possible?
On COMPANY_NAME, you get notified for roles aligned with your profile right from the start. When an employer posts a role that matches your qualifications and skills, you’ll know first. When you apply early, your chances of getting noticed and shortlisted increase by 20%.
COMPANY_NAME also offers direct employer responses—no more waiting for weeks. Here you engage with hiring managers who are actively looking for candidates.
When all these features combine in one place, you move from your first match to your first interview within days. And ultimately, from application to offer—all within 15 to 30 days!
3: The Type of Resume You Need to Get Priority Placement
With COMPANY_NAME, you don’t just need a resume—you need a strategy. A system that pushes your name to the right tables. We’ll show you exactly how the most successful candidates take initiative and get noticed.
4: Browse Full-Time, Part-Time, and Freelancing Roles With COMPANY_NAME
The job market isn’t one-size-fits-all—and your career shouldn’t be either. COMPANY_NAME gives you access to a wide range of opportunities including full-time, part-time, and freelancing roles all in one place.
5: COMPANY_NAME Helps You Grow Your Career
COMPANY_NAME provides insights, tools, and role-matching that help you find the right direction, the right skills, and the opportunities aligned with your ambition.
6: The Easiest Way To Find A Job
COMPANY_NAME cuts the noise, the endless scrolling, and the confusion. With accurate matches, direct employer connection, and real-time updates, you get a clear and simple path from application to interview.
7: Find Roles That Offer Growth, Culture & Benefits
COMPANY_NAME helps you find roles where you grow, feel supported, and thrive—not just survive. With us, you discover opportunities that elevate your professional life.
8: Get Support With Resume, Interviews & Career Planning
COMPANY_NAME provides expert guidance on resumes, interviews, and planning so employers instantly recognize your strengths and value.
9: Your Future Starts Today
COMPANY_NAME gives you everything you need—tools, guidance, and opportunities—to step forward confidently and begin a new chapter where your potential is seen and supported.
10: Get Hired Within 15 to 30 Days With COMPANY_NAME
COMPANY_NAME follows a smart, strategic, and proven approach that gets your profile noticed faster and moves you toward interviews and offers within 15 to 30 days.
Utilization Review Nurse RN Part-Time
Overview
Who We Are
Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.
Learn even more about the work that drives us at personifyhealth.com.
Responsibilities
We are seeking a Utilization Review Nurse to join our dynamic team on a part-time basis working up to 28 hours per week and weekends required.
What You'll Actually Do
- Perform utilization management (UM) medical-necessity reviews and level-of-care determinations for requested services using the organization’s hierarchy of guidance (benefit language/plan documents, medical policies, nationally recognized evidence-based criteria such as MCG; NCCN as applicable) and applicable state/federal requirements.
- Apply criteria and policy consistently; when a request does not meet criteria, route timely to the Medical Director for secondary clinical review and potential adverse determination in accordance with UM policies and accreditation standards (e.g., NCQA/URAC, as applicable).
- Use critical thinking to analyze clinical documentation for completeness, identify key risk/acuity indicators, recognize inconsistencies or missing information, and initiate timely outreach/escalation per UM workflow.
- Apply strategic thinking within established guidelines by prioritizing workload based on urgency, regulatory/accreditation time frames, and potential member impact; communicate barriers early to support timely, compliant determinations.
- Assist with in-network and benefit-compliant redirection when clinically appropriate by confirming eligibility, benefits, authorization requirements, and network status.
- Support the appeals process by preparing clinical summaries and documentation; coordinating peer-to-peer/MD discussions when indicated; and ensuring timely routing/escalation per policy (including Independent Review Organization (IRO) processes when required).
- Document reviews, rationale, criteria/policy citations, communications, and outcomes accurately and contemporaneously in designated UM systems to support quality oversight, reporting, and audit readiness.
- Meet established productivity, quality, accuracy, and turnaround-time standards; participate in calibration/quality activities; and incorporate feedback into daily practice.
- Maintain HIPAA compliance and confidentiality using minimum-necessary standards; complete required training and annual competencies within established deadlines.
- Cross-train and provide cross-coverage as needed to support team operations and service-level commitments.
Qualifications
What You Bring to Our Team
- Current, unrestricted RN license in the United States or U.S. territory (compact license acceptable where applicable).
- Graduate of an accredited nursing program (ADN or diploma required; BSN preferred).
- Minimum 1-2 years of recent clinical experience (e.g., acute care, med-surg, ICU/ED, or other relevant setting).
- Prior utilization review/utilization management experience preferred.
- Ability to interpret medical records and apply evidence-based criteria and plan medical policies with appropriate escalation to Medical Director for non-certifications.
UPON HIRE, must have:
- Basic computer literacy
- The ability to work on multiple screens, and proficient typing skills.
- Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook Excellent verbal and written communication skills
- Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
- Ability to work independently and utilize written resources to problem solve.
- Ability to work independently within appropriate programs after training.
- Knowledge of medical claims and ICD-10, CPT, HCPCS coding
- Excellent verbal and written communication skills for upward and downward conversations
Physical and Mental Requirements:
- Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards.
- Ability to maintain regular, punctual attendance.
- Ability to sit for 6-8 hours.
- Constant use of computer keyboard and mouse; repetitive use of both hands.
- Occasional to frequent twisting of neck; occasional bending of neck and at waist.
This job description is not an exclusive or exhaustive list of all job functions that an employee in this position may be asked to perform. Duties and responsibilities can be changed, expanded, reduced, or delegated by management to meet the business needs of MedCom.
Benefits
The Highlights:
- Competitive base salary and benefits effective day one
- Comprehensive medical and dental through our own health solutions (yes, we use what we build)
- Paid Time Off—rest and recharge time is non-negotiable
- Mental health support, retirement planning, and financial protection
- Professional development with clear career progression and learning budgets
- Mission-driven culture where diverse perspectives drive real impact on people's health
Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks.
Compensation: This position offers a base salary range of $30.00-$38.00 per hour, depending on location, skills, and experience. You're eligible for our full benefits package starting day one.
Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing.
Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to talent@personifyhealth.com. View all legitimate openings at personifyhealth.com/careers.
