Inpatient Utilization Management RN — Remote (CA)

Elevance Health; Los Angeles (CA); Hybrid; USD 57,000 - 95,000; Full time

Job summary

Elevance Health is seeking an RN Utilization Management Nurse (InPatient) for California HMO. The role is virtual full-time with in-person onboarding sessions; California candidates may receive overtime eligibility.

The position follows a hybrid work model with an 8-hour shift between 7:30am–6pm PST and rotating weekends/holidays. The candidate will analyze medical necessity, promote quality outcomes, collaborate with care teams, and advise on complex cases.

Qualifications

• Assesses member care using clinical guidelines and nursing judgment.
• Experience in care management and utilization review within managed care or hospital settings.
• Active CA RN license and nursing practice eligibility in state of California.

Responsibilities

• Analyzes members’ clinical information and applies guidelines to evaluate medical necessity.
• Collaborates with providers to promote quality outcomes and appropriate resource use.
• Assesses abnormalities by understanding complex clinical concepts and aggregated data.
• Assesses member care to ensure services align with diagnoses and level of care.
• Provides consultation to Medical Director on complex cases as needed.
• May recommend alternate types or levels of care based on nursing judgment and experience.
• Collaborates with case management on discharge planning and equipment needs.
• Offers nursing consultation to Medical Director or Providers on select cases.
• Serves as a resource to lower‑level nurses and participates in process improvement.

Skills

Nursing judgment

Care management

Utilization review

Education

Associate degree in nursing

Job description

Elevance Health is seeking an RN Utilization Management Nurse (InPatient) for California HMO. The role is virtual full-time with in-person onboarding sessions; California candidates may receive overtime eligibility.

The position follows a hybrid work model with an 8-hour shift between 7:30am–6pm PST and rotating weekends/holidays. The candidate will analyze medical necessity, promote quality outcomes, collaborate with care teams, and advise on complex cases.