Remote Utilization Review Nurse II – Nevada

Kaiser Permanente; Reno (NV); Remote; USD 90,000 - 120,000; Full time

Job summary

Kaiser Permanente in Reno, Nevada, is seeking an experienced Utilization Review Nurse II to support clinical reviews, coordinate care, and guide decisions on medical necessity and duration of treatment.

You will collaborate with physicians, care teams, and members to optimize cost of care, assist discharge planning, and ensure alignment with evidence-based guidelines. A Nevada RN license and utilization review experience are required.

Qualifications

• Bachelor's Degree in Nursing and at least 1 year of experience in direct patient care, utilization review/management, or discharge planning in a managed care setting or a related field.
• Registered Nurse License (Nevada) required at hire.
• Utilization review/management experience preferred.

Responsibilities

• Pursues effective relationships with others by sharing resources and knowledge; listens and responds to feedback; adapts to change.
• Completes work by applying up-to-date knowledge to meet deadlines; follows procedures and supports projects with limited guidance.
• Supports high-quality consultation by communicating on requirements Related to medical necessity and benefit denials across care continuum.
• Supports education and compliance initiatives by staying up-to-date with relevant regulations and guidelines.
• Assists in quality improvement by observing utilization patterns and adhering to utilization policies and workflows.
• Performs utilization reviews by following standard policies to evaluate medical necessity and efficiency of services.

Skills

Ambiguity/Uncertainty Management

Attention to Detail

Communication

Critical Thinking

Cross-Group Collaboration

Decision Making

Dependability

Diversity, Equity, and Inclusion

Drives Results

Facilitation Skills

Health Care Industry

Influencing Others

Integrity

Learning Agility

Organizational Savvy

Problem Solving

Short- and Long-term Learning

Teamwork

Topic-Specific Communication

Education

Bachelor's Degree in Nursing

Nevada RN License

Job description

Kaiser Permanente in Reno, Nevada, is seeking an experienced Utilization Review Nurse II to support clinical reviews, coordinate care, and guide decisions on medical necessity and duration of treatment.

You will collaborate with physicians, care teams, and members to optimize cost of care, assist discharge planning, and ensure alignment with evidence-based guidelines. A Nevada RN license and utilization review experience are required.