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:

• Provide clinically efficient and effective inpatient utilization management by reviewing acute hospital admissions and preauthorization requests
• Authorize healthcare services in compliance with medical necessity criteria and document clinical reviews accurately
• Collaborate with the Medical Management team for care coordination and prepare cases for review with Physician Leadership

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 required hours in Pacific or Mountain Time Zone