California Licensed Care Review RN

Job Summary

To support clinical member services, the full-time California Licensed Care Review RN will assess service requests for medical necessity, ensure compliance with guidelines, and collaborate with multidisciplinary teams in a remote setting.

Key responsibilities

• Assess services for members to ensure optimal outcomes and compliance with regulations
• Analyze clinical service requests against evidence-based clinical guidelines
• Conduct reviews to determine prior authorization and financial responsibility for treatments

Required qualifications

• At least 2 years of experience in hospital acute care, inpatient review, or managed care
• Active and unrestricted Registered Nurse (RN) license in California
• Ability to prioritize and manage multiple deadlines effectively
• Proficiency in Microsoft Office and applicable software programs
• Strong organizational and critical-thinking skills