California Licensed Utilization Review RN
Job Summary
Leading a clinical team, the full-time California Licensed Utilization Review RN will ensure timely care decisions by coaching reviewers on medical-necessity criteria, monitoring workflow, and maintaining documentation quality while working Monday to Friday, 8:00 AM to 5:00 PM Pacific Time with occasional Saturday coverage.
Key responsibilities
- Set daily direction for the UM team, establishing priorities and reinforcing expectations
- Coach reviewers on consistent application of medical-necessity criteria and benefit language
- Monitor workflow health, tracking intake volume and aging cases while recommending solutions to barriers
Required qualifications
- Active RN license
- Experience in utilization management, clinical review, or case management
- Background in applying medical-necessity criteria and benefit plan interpretation in a healthcare setting
- Proficiency with UM platforms and standard office/productivity tools
- Familiarity with medical terminology and coding concepts (ICD-10, CPT, HCPCS)
Complete Job Description
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