UM Review Nurse

CA-licensed Utilization Review Nurse to perform prior authorization and retrospective review of outpatient services for various health plans. Requires 1+ year of outpatient Utilization Management experience in a fast-paced setting. Remote position for CA-licensed nurses; candidates must live in California. Open availability between 8 AM and 8 PM PST and scheduled for 5 shifts per week; overtime may be required. Responsibilities include completing prior authorization and retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment; refer cases to Medical Directors as needed; maintain knowledge of state and federal regulations and accreditation standards; comply with internal policies and procedures; perform other duties as requested. Qualifications include active CA LVN license, 1+ year outpatient UM experience, and proficiency with Word/Excel/Outlook. Preferred additional experience includes health plan, IPA or MSO exposure and strong interpersonal and collaboration skills.