Interim Concurrent Nurse Reviewer

Northern California (Fully Remote)

Join our Utilization Management team as a Registered Nurse (RN) and help ensure members receive the right care at the right time. You’ll collaborate with providers, support discharge planning, and guide care decisions that improve outcomes across California.

Responsibilities:

• Confirm care plans and coordinate with providers
• Recommend transfers, levels of care, and discharges
• Escalate requests to the Medical Director as needed
• Resolve adjudication issues and maintain accurate documentation
• Track and report utilization data

Interim details:

• Start date early November, 2025.
• Basic knowledge of computers required.
• Able to work remotely, required.
• 3+-month Interim assignment, to start. Possibility of extension.
• Must be a current resident of California, required.

Requirements:

• Bachelor’s degree in nursing, from an accredited nursing program, required.
• Current California RN License required.
• 3+ years of clinical experience working in Acute care/ER/ICU/MedSurg/Telemetry within an acute care facility, required.
• Ability to read, interpret and apply complex written regulations, guidelines, and other materials, preferred.
• Experience in Case Management, Utilization Management, or discharge planning, preferred.
• Experience working with Medi-Cal and/or Medicare populations, strongly preferred.

Compensation: $55.00 per/hour

Key Characteristics:

• Effective Interpersonal skills
• Self-Starter