California Licensed Nurse RN 3

Job Summary

To support utilization review activities for Medicare members, the contract Nurse RN 3 will perform prospective, concurrent, and retrospective reviews, ensuring appropriate levels of care and effective discharge planning while working remotely.

Key responsibilities

• Conduct utilization reviews and first-level determination approvals using evidence-based guidelines
• Coordinate discharge planning and durable medical equipment needs based on member acuity
• Prepare cases for the Medical Director and ensure compliance with regulatory standards

Required qualifications

• Associate's degree in nursing required; bachelor's degree preferred
• Minimum of 2 years of utilization management experience
• At least 5 years of recent direct inpatient hospital patient care experience
• Valid and active nursing license as required by role and jurisdiction
• Proficiency with Windows, Excel, and Outlook