California Licensed Utilization Review Nurse

Job Summary

A company is looking for a Concurrent Utilization Review Nurse, RN (Work from home).

Key Responsibilities:

• Conduct timely reviews of inpatient and skilled nursing services to determine medical necessity and appropriateness
• Collaborate with the Medical Director on complex cases and provide comprehensive clinical summaries
• Process authorization requests and communicate with healthcare providers regarding treatment plans and documentation

Qualifications:

• Registered Nurse (RN) with an active, unrestricted California nursing license; BSN preferred
• 2-3 years of clinical nursing experience, with at least 1 year in utilization review or case management
• Experience in a managed care setting with medical necessity reviews is preferred
• Preferred certifications include Certified Professional in Utilization Review (CPUR) or Certified Case Manager (CCM)
• Strong knowledge of clinical guidelines and proficiency in electronic health records and utilization management software