California Licensed Utilization Management Nurse

Job Summary

A company is looking for an Inpatient Utilization Management Nurse, RN - Remote in PST or MST.

Key Responsibilities

• Conducts clinical reviews for inpatient admissions and authorization requests based on medical necessity criteria
• Documents clinical reviews and decisions accurately in the care management system
• Collaborates with the Medical Management team to coordinate care and identify members for care coordination programs

Required Qualifications

• Current unrestricted Registered Nurse (RN) license in state of residence
• 3+ years of clinical nursing experience in an acute care hospital or LTAC setting
• 1+ years of Utilization Management experience in a hospital or insurance setting
• Experience applying Medicare and/or Medicaid guidelines
• Ability to work in Pacific or Mountain time zone and meet required hours