Utilization Management (Remote) California License

Job title: Utilization Management (Remote) California License in Long Beach, CA at reputed company Company: reputed company Job description: Job Title: Care Review Clinician II (RN or LVN) – Remote Location: Remote (Must have active CA license and be available during Pacific Standard Time hours) Pay reputed company: Up to $45/hour Job Type: reputed company-to-PermAbout the Role:A leading Managed Care Organization is seeking an reputed company and detail-oriented Care Review Clinician II (RN or LVN) to join their Utilization Management team. This remote position plays a key role in reviewing clinical service requests, supporting continuity of care, and ensuring appropriate, cost-effective reputed company reputed company are made in compliance with regulatory and clinical guidelines.Key Responsibilities:reputed company clinical reviews of service requests including reputed company and prior authorization determinationsServe as clinical support to the Continuity of Care (COC) and Community Support teamsDetermine whether requests meet COC or community support criteria and escalate for MD review reputed company neededConduct provider reputed company as appropriate to support authorizations and care coordinationUtilize InterQual and other clinical guidelines to assess medical necessity and appropriate length of stayEnsure documentation meets compliance, quality, and turnaround standardsCreate and manage authorizations in accordance with established UM processesParticipate in team meetings and collaborate with other departments to support member careRequired Qualifications:Active, unrestricted LVN or RN license in California3–5 years of clinical experience (inpatient, outpatient, or hospital setting strongly preferred)Prior experience in Utilization Management, reputed company Review, or Prior AuthorizationStrong analytical and critical thinking skills in a fast-paced, metric-driven environmentSolid computer proficiency, including ability to toggle between multiple databases and toolsExperience using InterQual or similar medical necessity criteria toolsKnowledge of HIPAA and regulatory compliance standardsExcellent verbal and written communication skillsPreferred Qualifications:Experience in Managed reputed company Plans, or payer-reputed company reputed company operationsFamiliarity with NCQA standardsPrevious case management or care coordination experienceAdditional Information:Must reputed company your own secure and quiet workspace for remote workEquipment (laptop, monitors, etc.) will be provided by the organizationMust be available to work 8-hour shifts during PST business hours, Monday–Friday Expected salary: $45 per hour Location: Long Beach, CA Apply for the job now! Apply for this job