Job Summary

A healthcare company is filling a position for a Remote California Licensed Lead Utilization Management Nurse.

Core Responsibilities Include:

• Manage general, preauthorization and/or retrospective review of outpatient services
• Determine medical appropriateness and medical necessity for a variety of services
• Work with providers to meet the health care needs of members with the appropriate resources

Required Skills:

• Graduate of an approved nursing program
• A current, unrestricted California RN or LVN/LPN license
• 3+ years of experience clinical experience in an acute care facility
• OR equivalent combination of education and experience
• Payor experience and/or experience with nationally recognized clinical criteria, including MCG