Concurrent Utilization Review Nurse, RN (Work from Home)

Overview

Role involves conducting clinical reviews to ensure medical necessity and appropriateness of healthcare services.

Ideal candidate should have 2-3 years of clinical nursing experience and knowledge of clinical guidelines.

Locations

• United States, California

Requirements

• Active RN license in California
• 2-3 years clinical nursing experience
• 1 year in utilization review or case management
• Experience in managed care preferred

Responsibilities

• Conduct clinical reviews for medical necessity
• Collaborate with Medical Director
• Process authorization requests
• Facilitate care transitions
• Ensure compliance with regulations
• Educate providers on guidelines