Leading a clinical team, the full-time California Licensed Utilization Review RN will ensure timely care decisions by coaching reviewers on medical-necessity criteria, monitoring workflow, and maintaining documentation quality while working Monday to Friday, 8:00 AM to 5:00 PM Pacific Time with occasional Saturday coverage. Key responsibilities Set daily direction for the UM team, establishing priorities and reinforcing expectations Coach reviewers on consistent application of medical-necessity criteria and benefit language Monitor workflow health, tracking intake volume and aging cases while recommending solutions to barriers Required qualifications Active RN license Experience in utilization management, clinical review, or case management Background in applying medical-necessity criteria and benefit plan interpretation in a healthcare setting Proficiency with UM platforms and standard office/productivity tools Familiarity with medical terminology and coding concepts (ICD-10, CPT, HCPCS)
California Licensed Utilization Review RN in workfromhome at Unknown Company
This position is listed as full time and onsite.