RN Medical Management Specialist – Utilization & Case Mgmt (Remote)

SCAN Health Plan; Long Beach, Northern (CA, KY); Hybrid; USD 62,000 - 69,000; Full time

Benefits offered by this job

Remote work mode

401(k) with employer match

Competitive hourly rate

Job summary

SCAN Health Plan is seeking a Medical Management Specialist-RN (Temp) in Long Beach, CA. The role focuses on promoting appropriate inpatient and outpatient care, applying criteria, and coordinating complex cases within regulatory timelines.

You will collaborate with the Medical Director, manage utilization reviews, and support care transitions while maintaining confidentiality and high-quality service for SCAN members.

Qualifications

• Current and active California RN license.
• 3+ years of medical-surgical nursing experience.
• 3+ years of Utilization Management/Prior Authorization in a managed care setting.
• Knowledge of California managed care and Medicare/Medicaid programs.
• Proficient with Microsoft Word, Excel, Outlook, and PowerPoint.

Responsibilities

• Promotes and supports quality, medical necessity, and cost-effectiveness of care per regulatory guidelines.
• Apply clinical criteria and collaborate with Medical Director for reviews.
• Manage complex cases using case management and utilization review processes.
• Prepare case presentations and participate in IDT and rounds.
• Assist with urgent/out-of-network care and transitions back to SCAN network.

Skills

Nursing

Utilization Mgmt

CA RN

Analytical skills

Communication skills

MS Office

Education

Nursing degree

Tools

EHR systems

Job description

SCAN Health Plan is seeking a Medical Management Specialist-RN (Temp) in Long Beach, CA. The role focuses on promoting appropriate inpatient and outpatient care, applying criteria, and coordinating complex cases within regulatory timelines.

You will collaborate with the Medical Director, manage utilization reviews, and support care transitions while maintaining confidentiality and high-quality service for SCAN members.