Registered Nurse - Utilization Review - RNUR26-06086

Navitas Healthcare LLC

Job Title: Registered Nurse - Utilization Review

Location: Santa Rosa, CA

Shift Details: Day Shift | 5x8 Hours | 08:00 AM - 04:30 PM
Contract Duration: 13 Weeks
Orientation: 40 Hours (Non-Billable)
Required Qualifications

Active Registered Nurse (RN) License required
Minimum 1-2 years acute care experience preferred
Experience in Utilization Review, Case Management, or similar clinical coordination role preferred
Strong understanding of medical necessity criteria and payer guidelines
Knowledge of insurance authorization and review processes
Strong documentation, analytical, and communication skills
Ability to work independently in a remote setting
Experience with EMR systems preferred (Epic preferred)

Job Responsibilities

Perform utilization review for inpatient and outpatient services
Evaluate medical records for appropriate level of care and medical necessity
Process prior authorizations and continued stay reviews
Collaborate with physicians, case managers, and insurance payers
Document review decisions accurately in EMR systems
Identify cases requiring escalation to clinical reviewers or medical directors
Support discharge planning and care coordination when needed
Ensure compliance with regulatory, payer, and facility guidelines
Maintain productivity and quality standards in a remote environment

For more details contact at View email address on click.appcast.io

About Navitas Healthcare, LLC certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.

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Vacancy posted 2 days ago

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