Remote RN: Medical Management & Utilization Specialist (Temp)

SCAN Group; Long Beach (CA); Remote; USD 62,000 - 69,000; Full time

Benefits offered by this job

Remote Work Mode

401(k) Retirement Plan with employer-m

Team-based environment

Job summary

SCAN is seeking a Medical Management Specialist-RN in California to promote quality and cost-effectiveness of care under regulatory guidelines. You will support utilization management, conduct reviews, and coordinate with the Medical Director for complex requests.

Responsibilities include coordinating care across inpatient and outpatient settings, ensuring timely determinations, and maintaining strict documentation and privacy standards. Remote work mode is available.

Qualifications

• Nursing degree required and active California RN license.
• CPUM/CPUR or other medical case management certification preferred or willing to obtain within 2 years.
• 3+ years in medical‑surgical nursing and utilization management in managed care.

Responsibilities

• Ensure appropriate inpatient/outpatient care at the right time and location.
• Apply evidence-based criteria and regulatory guidelines to care decisions.
• Coordinate with Medical Director for secondary review of non-conforming requests.
• Maintain documentation and data entry per policy and protect patient privacy.
• Present cases and participate in interdisciplinary team meetings to inform care plans.

Skills

Analytical skills

Verbal & written communication

Multitasking

Team collaboration

Education

Nursing degree

California RN license

Tools

Microsoft Word

Excel

PowerPoint

Outlook

Job description

SCAN is seeking a Medical Management Specialist-RN in California to promote quality and cost-effectiveness of care under regulatory guidelines. You will support utilization management, conduct reviews, and coordinate with the Medical Director for complex requests.

Responsibilities include coordinating care across inpatient and outpatient settings, ensuring timely determinations, and maintaining strict documentation and privacy standards. Remote work mode is available.