California Licensed RN Care Manager

Job Summary

To support patient care quality and resource efficiency, a part-time remote California Licensed RN Care Manager in Utilization Management will review medical records, collaborate with healthcare providers and insurance companies, and ensure appropriate treatment plans while maintaining productivity and quality metrics.

Key responsibilities

• Completes clinical reviews of acute medical patients using the Optum/Inter Qual tool to assess treatment necessity and appropriateness
• Collaborates with healthcare professionals to develop and implement comprehensive patient care plans, facilitating communication among all stakeholders
• Stays updated on healthcare regulations and guidelines to ensure optimal service delivery and participates in required annual training

Required qualifications

• Associate's Degree in nursing or equivalent combination of education and experience
• Five years of acute hospital experience, preferably in critical care areas
• Two years of utilization review experience using the Optum/Inter Qual product within the last 12 months
• Registered Nurse (RN) licensure in the state of practice
• Bachelor's Degree in Nursing (BSN) is preferred