California Licensed Utilization Review Nurse

A company is looking for a Concurrent Utilization Review Nurse (Work from Home). Key Responsibilities Conduct real-time clinical reviews to assess medical necessity and appropriateness of healthcare services Collaborate with the Medical Director on complex cases and ensure compliance with health plan policies Process authorization requests and facilitate communication with healthcare providers and payers Qualifications Registered Nurse (RN) or Licensed Vocational/Practical Nurse (LVN/LPN) with an active California nursing license; BSN preferred 2-3 years of clinical nursing experience, with at least 1 year in utilization review or case management Experience in a managed care setting with medical necessity reviews is strongly preferred Preferred certifications include Certified Professional in Utilization Review (CPUR) or Certified Case Manager (CCM) Strong knowledge of clinical guidelines and medical necessity criteria

Mar 28, 2025 - 01:15

A company is looking for a Concurrent Utilization Review Nurse (Work from Home). Key Responsibilities Conduct real-time clinical reviews to assess medical necessity and appropriateness of healthcare services Collaborate with the Medical Director on complex cases and ensure compliance with health plan policies Process authorization requests and facilitate communication with healthcare providers and payers Qualifications Registered Nurse (RN) or Licensed Vocational/Practical Nurse (LVN/LPN) with an active California nursing license; BSN preferred 2-3 years of clinical nursing experience, with at least 1 year in utilization review or case management Experience in a managed care setting with medical necessity reviews is strongly preferred Preferred certifications include Certified Professional in Utilization Review (CPUR) or Certified Case Manager (CCM) Strong knowledge of clinical guidelines and medical necessity criteria