Utilization Review Nurse

SPECTRAFORCE; California (MO); Remote; USD 60,000 - 80,000; Full time

Job summary

SPECTRAFORCE is seeking a Registered Nurse III for remote work in California. The ideal candidate will possess strong clinical skills, a valid RN license, and experience in patient care. As part of a dedicated team, you will review care episodes and make medical necessity decisions. This role offers full-time hours with a competitive pay range, allowing for a flexible work environment.

Qualifications

• Requires a valid California RN license and preferred BSN.
• Experience in UM (Utilization Management) is a plus.
• Ability to work in a HIPAA compliant home office.

Responsibilities

• Review concurrent episodes of care making medical necessity decisions.
• Work within various clinical units including Case Management and Prior Authorization.

Skills

Strong Clinical Background

Direct Patient Care Experience

Strong Computer Skills

Ability to Work from Home

Education

Valid California RN License

BSN (Bachelor of Science in Nursing)

Tools

Windows Based Software

Job description

This range is provided by SPECTRAFORCE. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$40.00/hr - $45.00/hr

Direct message the job poster from SPECTRAFORCE

Senior Recruiter at SPECTRAFORCE Technologies

Job Description:

Position Title: Registered Nurse III

Work Location: Remote in California

Assignment Duration: 6+ months.

Work Schedule: 08:00 AM PST – 4:30 PM PST with ½ hour lunch, or 5:00 PM PST with 1 hour lunch

Position Summary:

• Review of Concurrent review episodes of care making Medical Necessity decisions.

Key Responsibilities:

• Review of Concurrent review episodes of care making Medical Necessity decisions.

Qualification & Experience:

• Strong Clinical Background, Direct Patient care experience
• Strong Computer Skills
• Ability to work from HIPPA compliant home office Self directed
• Preferred: UM experience
• Preferred: Use of MCG Criteria
• Valid Ca. RN license, BSN preferred
• Windows Based software knowledge

Notes:

• Business unit candidate will work: Case Management, Prior Auth, and other clinical based units within our organization.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care and Hospitals

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