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Utilization Management Clinical Reviewer (California) - Remote

🕒 4 days ago
RN LicensureClinical AssessmentCare CoordinationMedical Necessity Evaluation

📜 Description

  • Manage and coordinate an assigned caseload of complex, high-acuity inpatient cases.
  • Complete clinical reviews for acute inpatient care, rehabilitation, and outpatient services.
  • Prioritize cases, request clinical information, and document decisions accurately.
  • Create member-centered care plans with measurable goals and follow-up timeframes.
  • Educate members about benefits and care options to support their health decisions.

🛠️ Requirements

  • Active, unencumbered California RN licensure.
  • A minimum of two years of direct clinical RN experience in an inpatient or managed care setting.

Benefits

  • Medical
  • Vision
  • Dental
  • 401(k) and company-paid life insurance.
  • Tuition reimbursement.
  • Minimum of 18 days of paid time off per year and paid holidays.
  • Apply clinical guidelines to evaluate medical necessity and discharge needs.
Full job description

Join our team as a Utilization Management Clinical Reviewer, where you'll manage caseloads and coordinate care transitions while advocating for members' health needs.

Description

  • Manage and coordinate an assigned caseload of complex, high-acuity inpatient cases.
  • Complete clinical reviews for acute inpatient care, rehabilitation, and outpatient services.
  • Prioritize cases, request clinical information, and document decisions accurately.
  • Create member-centered care plans with measurable goals and follow-up timeframes.
  • Educate members about benefits and care options to support their health decisions.

Requirements

  • Active, unencumbered California RN licensure.
  • A minimum of two years of direct clinical RN experience in an inpatient or managed care setting.

Benefits

  • Medical
  • Vision
  • Dental
  • 401(k) and company-paid life insurance.
  • Tuition reimbursement.
  • Minimum of 18 days of paid time off per year and paid holidays.
  • Apply clinical guidelines to evaluate medical necessity and discharge needs.

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