Medix Partners with National TPA to Deliver Utilization Review Nurse Staffing in Just 7 Days

What happens when a utilization review (UR) backlog grows to the point where compliance deadlines, financial risk, and member care are all on the line at once?

For a national third-party administrator, this wasn’t a hypothetical question—it was an operational crisis unfolding in real time. With UR cases piling up and internal nurses overwhelmed, the organization faced a critical utilization review nurse staffing gap and needed experienced clinical talent immediately to restore stability and protect performance standards. Medix became the partner they relied on to turn things around.

About the Client

• A large, U.S.-based third-party administrator providing administrative, clinical, and medical management services for employer-sponsored and health plan populations
• Supports high-volume health plan operations, processing millions of medical claims annually while maintaining compliance, accuracy, and service-level expectations
• Manages complex medical management operations where timely utilization review is critical to maintaining service levels and operational performance

The Challenge

The organization faced a growing utilization review backlog that its internal medical management team did not have the capacity to absorb. Case volume had increased rapidly, creating pressure on turnaround times and placing additional strain on nurses already managing full workloads. Because utilization review requires specialized clinical experience, quickly hiring and onboarding internal staff was not a viable option.

The immediate need was clear: the organization required experienced UR nurses who could step in quickly, work remotely, and help resolve the backlog within a defined timeframe. Without swift external support, delays risked impacting operational performance and service expectations for health plan partners.

The Solution

The client partnered with Medix after recognizing the need for a staffing firm that could respond quickly to an urgent utilization review backlog and deliver experienced clinical talent without delay.

Backed by a proven track record supporting similar medical management initiatives and over 20 years of industry experience, the client chose Medix for these additional reasons:

• Confidence rooted in prior success at a different organization, giving stakeholders assurance in Medix’s ability to deliver despite no previous engagement with the current organization
• Quality of clinical talent, including nurses with strong utilization review and medical management experience who were also well-suited for remote work environments and productivity expectations
• Speed and responsiveness, enabling rapid deployment within tight operational timelines
• A collaborative partnership model, ensuring aligned expectations and transparent communication throughout the project

The Results

Medix deployed a team of 10 high-quality utilization review nurses in only 7 days, resolving a critical backlog within the original project window and prompting the client to extend the partnership for additional work.

• Backlog Resolution Within the Defined Scope: The initial cohort of RNs and LPNs successfully reduced the utilization review backlog within the agreed-upon timeframe, restoring workflow efficiency and relieving pressure on the internal medical management team.
• Specialized Utilization Review Talent Delivered at Speed: Utilization review nurses are often cited as one of the most difficult clinical skill sets to source. By leveraging a deep, specialized talent network, Medix was able to deliver experienced UR nurses quickly—demonstrating consistent access to a candidate pool that many organizations struggle to reach.
• Rapid Deployment With Minimal Ramp-Up in a Remote Environment: Because the nurses selected had prior utilization review experience and were prepared for remote work expectations, they integrated quickly and began contributing almost immediately, without extended onboarding or disruption to existing processes.
• Higher-Quality Clinical Alignment From the Start: Rather than supplying available clinicians, Medix focused on identifying nurses who aligned with the client’s documentation standards, workflow expectations, and performance requirements. This recruitment-first approach resulted in stronger consistency, faster ramp-up, and performance that supported extending the engagement beyond the original scope.
• Operational Stability and Continuity Restored: With the backlog under control and consistent clinical support in place, internal teams were able to refocus on day-to-day responsibilities, improving turnaround times and reducing operational strain.

Is your organization facing utilization review backlogs or difficulty sourcing experienced clinical reviewers? Medix delivers specialized utilization review talent quickly, without compromising quality or fit. Contact us today to discuss how we can support your medical management team.