Top 4 Utilization review nurse Jobs in Sumter, Sc

Remote Utilization Management Nurse (Inpatient Review – RN or LVN) MUST HAVE ACTIVE CALIFORNIA LIC.
Dragonfly Global —United States
- $100,000 - $105,000 a year
- Full-time
- Remote
- Spanish
- Nursing
- Microsoft Excel
- Travel reimbursement
- Health savings account
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Remote Utilization Management Nurse (Inpatient Review – RN or LVN) MUST HAVE ACTIVE CALIFORNIA LIC.
Dragonfly Global —United States
This position is *remote*, though an active _*California nursing license is required*_. Current, unrestricted *California RN or LVN license*.
$100,000 - $105,000 a year
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Remote Utilization Management Nurse (Inpatient Review – RN or LVN) MUST HAVE ACTIVE CALIFORNIA LIC.

Dragonfly Global
United States

Quick Apply

Job Details

Full-time
$100,000 - $105,000 a year

Benefits

Travel reimbursement
Health savings account
Paid holidays
Disability insurance
Health insurance
Dental insurance
401(k)
Flexible spending account
Paid time off
Parental leave
Employee assistance program
Vision insurance
401(k) matching
Employee discount
Professional development assistance
Flexible schedule
Life insurance
Referral program
Retirement plan

Qualifications

Inpatient experience
Medicare
LVN
RN License
CMS
CMS regulatory compliance
Health insurance knowledge
Medicare regulations
Document review
Concurrent review in utilization management
Associate's degree

Full Job Description

Job Type: Full-time
Schedule: Monday - Friday. Tuesday- Saturday. Or Sunday - Thursday.

8:00 AM – 5:00 PM PST
Location: Remote (California license required - CA is NOT a compact state))

Job Summary
We’re seeking an experienced Utilization Management Nurse (RN or LVN) to support inpatient review and care coordination for patients requiring ongoing medical oversight. This role is designed for nurses who want to make an impact by ensuring patients receive safe, appropriate, and cost-effective care. You’ll partner with physicians, hospital staff, and case managers to coordinate treatment plans and transitions of care.

This position is remote, though an active California nursing license is required.

Responsibilities

Perform inpatient concurrent reviews and assess admissions/continued stays using MCG (Milliman Care Guidelines).
Provide oversight for patients with complex or chronic conditions, identifying those who may require post-discharge case management.
Communicate with physicians, case managers, and discharge planners to coordinate patient care plans.
Participate in interdisciplinary team meetings and patient rounds.
Accurately document clinical activities and case updates in the care management system.
Track case progress and provide updates to UM leadership.
Monitor for overutilization or underutilization patterns and escalate concerns when needed.

Qualifications

Required:

Current, unrestricted California RN or LVN license.
At least 2 years of inpatient review, case management, or utilization management experience.
Familiarity with evidence-based criteria such as Milliman Care Guidelines (MCG) and CMS Guidelines.

Preferred (not required):

3+ years of nursing experience in a managed care setting.
IPA or Health Plan experience
Background in Medicare Managed Care.
Experience with utilizing clinical criteria such as Milliman, InterQual, CMS National and Local Coverage Determinations (LCD).
Associates or Bachelor’s degree in Nursing.
Strong critical thinking and problem-solving skills.
Excellent communication and interpersonal abilities.
Comfortable working in a fast-paced environment with multiple priorities.
Proficiency in Microsoft Word, Excel, and Outlook.

What We Offer

Remote position – work from home with a California license.
Competitive compensation (range dependent on location and experience).
Comprehensive benefits package, including:
Medical, dental, and vision insurance.
401(k) retirement plan with employer contributions.
Paid time off, personal days, and holidays.
Life insurance and disability coverage.
Ongoing training and career development opportunities.

Job Type: Full-time

Pay: $100,000.00 - $105,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Disability insurance
Employee assistance program
Employee discount
Flexible schedule
Flexible spending account
Health insurance
Health savings account
Life insurance
Paid time off
Parental leave
Professional development assistance
Referral program
Retirement plan
Travel reimbursement
Vision insurance

Experience:

CMS Guidelines: 1 year (Required)
Utilization Management Inpatient Review: 1 year (Required)
Medicare: 1 year (Required)
Inpatient/Concurrent Utilization Review: 1 year (Required)

Language:

Fluent Spanish (Preferred)

License/Certification:

Unexpired CALIFORNIA Nursing License (CA is NOT compact) (Required)

Location:

United States (Required)

Work Location: Remote

Quick Apply

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utilization review nurse jobs in sumter, sc

Remote Utilization Management Nurse (Inpatient Review – RN or LVN) MUST HAVE ACTIVE CALIFORNIA LIC.

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