Utilization Management Nurse, RN (Remote)

Key Responsibilities:

• Conduct prospective, concurrent, and retrospective reviews for medical necessity and appropriateness of services.
• Collaborate with UM Medical Director on reviews and final determination.
• Draft denial language to ensure consistent application of standardized, nationally recognized UM criteria.

Qualifications:

• Minimum two years of clinical patient care experience in an acute care facility with an active RN license.
• High school diploma or GED required; Bachelor's degree in nursing preferred.
• Possession of an active, unrestricted Registered Nurse license issued by the California BRN required.

Benefits:

• Competitive salary and telecommute schedule.
• Medical, dental, and vision insurance with life and disability options.
• CalPERS retirement and 457(b) option with contribution match.