California Licensed Utilization Management Nurse

To support the Utilization Management team, the full-time temporary California Licensed Utilization Management Nurse will ensure prior authorization requests meet contractual requirements, perform concurrent and post-service reviews of acute inpatient care, and participate in Utilization Management Care Programs while working remotely in California. Key responsibilities Ensure prior authorization requests are completed according to contractual requirements and evidence-based standards Perform concurrent or post-service reviews of acute inpatient care services using established criteria Participate in Utilization Management Care Programs Required qualifications Current unrestricted license as a Registered Nurse issued by the State of California Bachelor's degree in Nursing preferred, or an Associate's degree with a minimum of five years of experience in a patient care setting, including one year in Utilization Management or Case Management Working knowledge of managed care, Medicare D-SNP, Medi-Cal programs, and related regulations Familiarity with Centers for Medicare & Medicaid Services (CMS) guidelines Knowledge of Utilization Management and clinical nursing principles