California Licensed Utilization Management RN

Job Summary

A company is looking for an Outpatient Utilization Management RN (Remote in CA).

Key Responsibilities

• Reviews authorization requests for medical necessity and appropriateness of services
• Processes medical necessity denials and documents reasons in the authorization system
• Coordinates with health plans to ensure compliance with legislative and accreditation standards

Required Qualifications

• Registered Nurse with an active California License
• Proficient in computer use within a Microsoft Windows environment
• 5+ years of RN experience (preferred)
• Experience in utilization management in a managed care environment (preferred)