California RN Utilization Review

Job Summary

Providing comprehensive utilization reviews, the full-time California RN Utilization Review will conduct prospective, retrospective, and concurrent reviews for Southern California ministries while working remotely during 8-hour day shifts.

Key responsibilities

• Conduct clinical reviews and medical record assessments daily for all payers during patient admissions
• Manage a diverse workload in a fast-paced regulatory environment, ensuring compliance with utilization management standards
• Utilize strong negotiation and decision-making skills to determine medical necessity and patient status

Required qualifications

• Associate's Degree in Nursing
• California Registered Nurse License upon hire
• Two years of experience in a remote utilization review environment or as an acute hospital case manager