Looking for an experienced California RN or LVN with strong Utilization Management and inpatient review experience?
We’re hiring for a 100% REMOTE opportunity focused on inpatient clinical review, utilization management, and complex discharge planning.
Pay: $40–$50.48/hr, based on experience & licensure
Contract: Temporary contract with potential to convert based on business needs & performance
What you’ll do:
- Manage the full UM process through discharge planning
- Apply MCG criteria to clinical reviews
- Apply LCD/NCD and Medicare guidelines
- Coordinate complex SNF and ARU placements
- Participate in multidisciplinary rounds
- Collaborate with Medical Directors, physicians & hospital teams
- Active, unencumbered California RN or LVN license
- Commercial UM background (nurses who possess a fast pace and a sharp sense of urgency).
- Hands-on MCG expertise with inpatient acute/SNF reviews
- Strong background in Medicare Advantage due to strict CMS turnaround timelines and complex observation vs. inpatient criteria.
- Strong background in Medicare Advantage due to strict CMS turnaround timelines and complex observation vs. inpatient criteria.
If you have strong MCG + Medicare/inpatient review experience and are ready to take your UM expertise into a fully remote role,
#J-18808-LjbffrUtilization Review Nurse - 258847 in ca at Unknown Company
This position is listed as contract and able to be worked remotely.