🛠 Tech Stack

💼 About This Role

You'll conduct real-time clinical reviews to ensure medical necessity and appropriateness of healthcare services for members under a managed care health plan. You'll collaborate with the Medical Director on complex cases and coordinate with providers to facilitate timely authorizations and discharges. This role offers a chance to impact patient care through evidence-based utilization management in a value-driven healthcare organization.

🎯 What You'll Do

• Conduct timely concurrent reviews of inpatient and skilled nursing services using clinical guidelines.
• Collaborate with Medical Director for complex cases and denials.
• Process authorization requests and communicate with health plan payers.
• Support discharge planning and care coordination with case managers and social workers.
• Ensure compliance with state, federal, and accreditation standards.

📋 Requirements

• Active, unrestricted Registered Nurse (RN) license in California.
• Minimum 2-3 years of clinical nursing experience.
• At least 1 year in utilization review or case management.
• Strong knowledge of clinical guidelines (InterQual, MCG) and medical necessity criteria.

✨ Nice to Have

• Bachelor of Science in Nursing (BSN).
• Certification in Utilization Review (CPUR) or Case Management (CCM/ACM).
• Experience in a managed care setting with medical necessity reviews.

🎁 Benefits & Perks

• 🏖️ Paid Time Off
• 🏥 Health Insurance (medical, dental, vision)
• 📈 401(k) Retirement Plan
• 📚 Continuing Education Support
• 👩‍⚕️ Professional Development Opportunities

📨 Hiring Process

Estimated timeline: 2-4 weeks · AI estimate

1. 1Phone Screen· 30 min
2. 2Technical Interview· 60 min
3. 3Behavioral Interview· 45 min