Remote Utilization Management (UM) Nurse – California RN License Required
Pay: $40/hour
Job Type: Long-Term Contract
Location: 100% Remote
Schedule: Monday–Friday, 8:00 AM–5:00 PM PDT (Flexibility to work evenings, weekends, and holidays as needed)
Job Summary
We are seeking an experienced Utilization Management (UM) Nurse with an active California RN License for an immediate remote opportunity. This is a non-patient-facing position focused on reviewing medical records, determining medical necessity, and ensuring high-quality, cost-effective care.
Responsibilities
- Perform prospective, retrospective, and concurrent utilization reviews.
- Review medical records for medical necessity using established clinical guidelines.
- Apply Medicare, Medicaid/Medi-Cal, MCG, InterQual, and health plan-specific criteria.
- Collaborate with Medical Directors regarding adverse determinations.
- Ensure timely discharge planning and communication with care transition teams.
- Meet productivity and quality performance standards.
- Serve as a clinical resource for non-clinical team members when appropriate.
Qualifications
- Active California RN License (Required)
- Minimum 2 years of Utilization Management or Medical Management experience
- Inpatient Utilization Review experience required
- Working knowledge of MCG, InterQual, and NCQA standards
- Associate Degree in Nursing preferred
Benefits
- 100% Remote Opportunity
- Competitive Pay: $40/hour
- Long-Term Contract
- Immediate Start
- Stable work with a leading healthcare organization
Apply today by submitting your updated resume and active California RN License. Immediate interviews are being scheduled.
Regards
Swati
Quantum Technologies
Contact No.- 631-447-4863
Email- [email protected]
Pay: $40.00 per hour
Experience:
- Utilization management: 1 year (Required)
License/Certification:
- RN License (Required)
- BLS (Required)
Work Location: In person
