Utilization Review Nurse

Akkodis; Oakland (CA); Remote; USD 60,000 - 80,000; Full time

Job summary

Akkodis is seeking a Concurrent Review Nurse for a 3.5 month contract to ensure appropriate member care in a remote role based in California. The nurse will conduct concurrent reviews, collaborate with healthcare providers, and manage care issues, requiring strong clinical judgment and regulatory knowledge.

Benefits

Medical insurance

Dental insurance

Vision insurance

401K plan

Paid Sick Leave

Qualifications

• Minimum of three years of clinical experience as a Registered Nurse.
• Experience in case management preferred.

Responsibilities

• Conduct concurrent reviews of inpatient activities for appropriate care levels.
• Confirm care plans and collaborate with healthcare providers.

Skills

Clinical judgment

Analytical thinking

Problem-solving

Interpersonal skills

Organizational skills

Communication skills

Education

Graduate of an accredited nursing program

Unrestricted Registered Nurse license in California

Tools

Microsoft Word

Microsoft Excel

Job description

Akkodis is hiring a Concurrent Review Nurse to support our client in the Healthcare space.

All potential candidates should read through the following details of this job with care before making an application.

Location : Remote (must be based in California)

Employment type : 3.5 month contract

Pay : $55 / hr

The Concurrent Review Nurse conducts concurrent reviews of inpatient activities. This role is responsible for ensuring that member care is provided at the most appropriate level, for the appropriate duration, and in compliance with regulatory and contractual requirements. The work is varied and complex, requiring moderate discretion and independent judgment.

Essential Functions :

• Confirm care plans with healthcare providers.
• Identify care issues and collaborate with providers to resolve them; escalate when necessary.
• Make timely and appropriate recommendations regarding transfers, level of care determinations, and discharge planning.
• Escalate non-standard requests to the Medical Director for review; authorize or deny services as directed.
• Research and resolve adjudication issues promptly and accurately.
• Document all activities in the appropriate systems according to organizational standards.
• Track and compile data as required; produce and submit routine reports.

Qualifications :

Education and Experience

Required :

• Graduate of an accredited nursing program.
• Minimum of three (3) years of clinical experience as a Registered Nurse in a hospital or clinic setting.

Preferred :

• Experience in case management, utilization management, or discharge planning.
• Experience working in a managed care environment.
• Experience working with Medi-Cal and / or Medicare populations.

Licensure and Certifications

• Unrestricted Registered Nurse license in the State of California.

Knowledge, Skills, and Abilities :

• Strong clinical judgment within the scope of RN practice in California.
• Ability to interpret and apply complex clinical and regulatory guidelines.
• Detail-oriented with a focus on accuracy and completeness.
• Demonstrated ability to manage a varied workload efficiently.
• Proficient in problem-solving, assessment, and analytical thinking.
• Basic negotiation and conflict-resolution skills.
• Effective interpersonal and communication skills, both written and verbal.
• Strong organizational and time-management skills; able to prioritize and meet deadlines.
• Customer service-oriented with a commitment to excellence.
• Proficiency in Microsoft Word and Excel.
• Ability to navigate and document in multiple software systems and databases.
• Ability to handle confidential information with discretion.

Equal Opportunity Employer / Veterans / Disabled

Benefit offerings include medical, dental, vision, term life insurance, short-term disability insurance, additional voluntary benefits, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State or local law; and Holiday pay upon meeting eligibility criteria. Disclaimer : These benefit offerings do not apply to client-recruited jobs and jobs which are direct hire to a client

To read our Candidate Privacy Information Statement, which explains how we will use your information, please visit https : / / www.modis.com / en-us / candidate-privacy /

The Company will consider qualified applicants with arrest and conviction records.

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