California Licensed Utilization Review 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 based on medical necessity criteria
• Documents clinical reviews and decisions in the care management system, ensuring timely and accurate records
• 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
• Experience with Milliman (MCG) or InterQual guidelines