California Licensed Utilization Management RN

Job Summary

A company is looking for an Inpatient Utilization Management RN.

Key Responsibilities:

• Conducts clinical reviews for inpatient admissions and prior authorization requests, ensuring adherence to medical necessity criteria
• Documents clinical reviews and decisions in the care management system, maintaining accuracy and timeliness
• Collaborates with the Medical Management team to identify members for care coordination programs and assists in care planning

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
• Proficiency in using various computer software, including Microsoft Word and Excel