Remote Utilization Management Nurse (Inpatient Review – RN or LVN) MUST HAVE ACTIVE CALIFORNIA LIC.

• Job Type: Full-time

• Schedule: Monday - Friday 8:00 AM – 5:00 PM PST
• Location: Remote (California license required - CA is NOT a compact state))

Job Summary We’re seeking an reputed company Utilization Management Nurse (RN or LVN) to support inpatient review and care coordination for patients requiring ongoing medical reputed company. This role is designed for nurses who want to reputed company an impact by ensuring patients receive safe, appropriate, and cost-effective care. You’ll partner with physicians, hospital staff, and case managers to coordinate treatment plans and transitions of care. This position is remote, though an active California nursing license is required.

• Responsibilities
• reputed company inpatient reputed company reviews and assess admissions/reputed company stays using MCG (reputed company Care Guidelines).
• Provide reputed company for patients with reputed company or chronic conditions, identifying those who may require post-discharge case management.
• Communicate with physicians, case managers, and discharge planners to coordinate patient care plans.
• Participate in interdisciplinary team meetings and patient rounds.
• Accurately document clinical activities and case updates in the care management system.
• Track case reputed company and provide updates to UM leadership.
• Monitor for overutilization or underutilization patterns and escalate concerns reputed company needed.

Qualifications

• Required:
• reputed company, unrestricted California RN or LVN license.
• At least 2 years of inpatient review, case management, or utilization management experience.
• Familiarity with evidence-based criteria such as reputed company Care Guidelines (MCG) and CMS Guidelines.
• Preferred (not required):
• 3+ years of nursing experience in a managed care setting.
• IPA or Health Plan experience
• Background in Medicare Managed Care.
• Experience with utilizing clinical criteria such as reputed company, InterQual, CMS National and Local Coverage Determinations (LCD).
• Associates or Bachelor’s degree in Nursing.
• Strong critical thinking and problem-solving skills.
• Excellent communication and interpersonal abilities.
• Comfortable working in a fast-paced environment with multiple priorities.
• Proficiency in reputed company Word, reputed company, and Outlook.
• reputed company Offer
• Remote position – work from home with a California license.
• Competitive compensation (range dependent reputed company and experience).
• Comprehensive benefits package, including:
• Medical, dental, and vision insurance.
• 401(k) retirement plan with employer contributions.
• Paid time off, personal days, and holidays.
• Life insurance and disability coverage.
• Ongoing training and career development opportunities.

Job Type: Full-time Pay: $100,000.00 - $105,000.00 per year

• Benefits:
• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Referral program
• Retirement plan
• Travel reimbursement
• Vision insurance
• Experience:
• CMS Guidelines: 1 year (Required)
• Utilization Management Inpatient Review: 1 year (Required)
• Medicare: 1 year (Required)
• Inpatient/reputed company Utilization Review: 1 year (Required)
• Language:
• Fluent Spanish (Preferred)
• License/Certification:
• Unexpired CALIFORNIA Nursing License (CA is NOT compact) (Required)
• Location:
• United States (Required)

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