Utilization Review RN — Clinical Care & Authorization

United Staffing Associates; Bakersfield (CA); On-site; USD 55,000 - 74,000; Full time

Job summary

United Staffing Associates is seeking an experienced Utilization Review Nurse to support an organization in the healthcare sector. The RN will evaluate inpatient medical necessity, collaborate with providers, patients, and care teams, and ensure appropriate use of resources.

Ideal candidates hold an active RN license, an associate degree in Nursing, and 2+ years of clinical nursing experience in relevant settings.

Qualifications

• Active, unrestricted RN license.
• Minimum two years of full-time clinical nursing experience in acute care, community/public health, or chronic disease management.
• Experience educating patients and caregivers about health conditions and ongoing care.
• Understanding of managed care operations, utilization management, and healthcare regulations.
• Strong communication, critical thinking, and organizational skills.

Responsibilities

• Evaluate medical necessity and appropriateness of inpatient services through initial, ongoing, and follow-up reviews.
• Assess clinical information against guidelines to make initial authorization decisions.
• Collaborate with care teams to support discharge planning and care continuity.
• Identify patients who may benefit from care management or social services and facilitate referrals.
• Coordinate services and assist with interpreting benefits and coverage.
• Maintain accurate clinical documentation and authorization records.
• Communicate with patients, caregivers, and internal teams to address care needs.
• Assist with training and supporting new team members.

Skills

RN license

2+ years clinical nursing

healthcare education for patients

care coordination understanding

communication skills

independent work

Education

Associate's degree in Nursing

Bachelor's degree in Nursing/Health Administration or related field (preferred)

Tools

Microsoft Office

Electronic health records (EHR) systems

Job description

United Staffing Associates is seeking an experienced Utilization Review Nurse to support an organization in the healthcare sector. The RN will evaluate inpatient medical necessity, collaborate with providers, patients, and care teams, and ensure appropriate use of resources.

Ideal candidates hold an active RN license, an associate degree in Nursing, and 2+ years of clinical nursing experience in relevant settings.