Remote RN Clinical Review Nurse

Position Highlights:

• Location: Remote (California-based candidates or CA RN license required)
• Schedule: Monday–Friday, 8:00 AM–5:00 PM PST
• Start Date: October 20
• Training: Full-time training for the first month (cameras on, no time off during ramp-up)

Key Responsibilities:

• Conduct concurrent reviews to assess medical necessity and appropriate level of care
• Collaborate with providers, medical directors, and internal teams to support discharge planning
• Document clinical findings and manage member records in health systems
• Educate providers on utilization processes and care guidelines
• Support quality assurance and contribute to strategic initiatives

Requirements:

• Active California RN license
• Associate or Bachelor’s degree in Nursing
• 2–4 years of experience in concurrent review or utilization management
• Strong communication skills, attention to detail, and tech proficiency (InterQual, OneNote, Teams, Excel)