Utilization Review Nurse

Base pay range $35.00/hr - $43.00/hr Job Title Clinical Review Nurse – Concurrent Review Location: Remote (California only – must reside in CA or hold an active CA RN license) Duration: 12 months (with potential to extend or convert) Schedule: Training 8 AM – 5 PM PST (approx. 4 weeks, cameras on, no time off). Regular work schedule 8 AM – 5 PM PST. About the Role The Clinical Review Nurse – Concurrent Review will perform utilization management functions to ensure members receive the right care at the right time. This role focuses on discharge planning, concurrent reviews, and medical necessity determinations in alignment with InterQual and organizational guidelines. Responsibilities Conduct concurrent reviews of member care, length of stay, acuity, and discharge plans. Review member transfers or discharges to ensure timely coordination between care levels and facilities. Collaborate with providers, care management, and medical directors to ensure appropriate and cost-effective care. Complete 17–20 reviews per day while maintaining high-quality standards. Manage and document concurrent review findings, discharge plans, and medical determinations in health management systems. Educate providers on utilization processes to promote quality, appropriate care. Support interdepartmental projects and report trends, offering recommendations for process improvement. Provide subject matter expertise and guidance to utilization management teams. Candidate Requirements Education: ADN or BSN; Graduate from an accredited school of nursing. Experience: 2–4 years of related experience, including concurrent review and InterQual . Preferred: TruCare experience. Technical Skills: Proficiency in InterQual, Microsoft OneNote, Word, Excel, and Teams. Soft Skills: Strong communication, ability to thrive in a fast-paced environment, detail-oriented, and tech-savvy. Time-off requests during the first 90 days of employment. What Makes This Role Unique You’ll be part of a supportive, collaborative team. Every review helps ensure quality healthcare outcomes while supporting cost-effective delivery . Leadership emphasizes clarity, accountability, and growth with clear expectations and feedback. #J-18808-Ljbffr