California Licensed RN Utilization Review

Job Summary

To support utilization management processes, the part-time California Licensed RN Utilization Review will conduct prospective, retrospective, and concurrent reviews of medical records remotely, ensuring compliance with health plan requirements while managing a diverse workload in a fast-paced environment.

Key responsibilities

• Conduct clinical reviews and medical record evaluations daily during patient admissions for all payers
• Manage utilization review processes to determine medical necessity and patient status effectively
• Collaborate with healthcare teams to negotiate and communicate patient care needs and decisions

Required qualifications

• Associate's degree in nursing
• California Registered Nurse License upon hire
• Two years of experience in a remote utilization review environment or as an acute hospital case manager