Acute Care, Analysis Skills, Case Management, Clinical Medicine, Communication Skills, Customer Escalations, Discharge Plans, Documentation, Documentation Review, Electronic Medical Records, Epic Systems, Health Informatics, Healthcare, Hospital, Insurance, Maintain Compliance, Medical Records, Outpatient Care, Patient Care, Quality Management, Quality Metrics, Quality of Care, Registered Nurse (RN), Regulatory Compliance, Utilization Management
Job Title: Registered Nurse – Utilization Review
Location: Santa Rosa, CA
Shift Details: Day Shift | 5x8 Hours | 08:00 AM – 04:30 PM
Contract Duration: 13 Weeks
Orientation: 40 Hours (Non-Billable)
Required Qualifications
- Active Registered Nurse (RN) License required
- Minimum 1–2 years acute care experience preferred
- Experience in Utilization Review, Case Management, or similar clinical coordination role preferred
- Strong understanding of medical necessity criteria and payer guidelines
- Knowledge of insurance authorization and review processes
- Strong documentation, analytical, and communication skills
- Ability to work independently in a remote setting
- Experience with EMR systems preferred (Epic preferred)
Job Responsibilities
- Perform utilization review for inpatient and outpatient services
- Evaluate medical records for appropriate level of care and medical necessity
- Process prior authorizations and continued stay reviews
- Collaborate with physicians, case managers, and insurance payers
- Document review decisions accurately in EMR systems
- Identify cases requiring escalation to clinical reviewers or medical directors
- Support discharge planning and care coordination when needed
- Ensure compliance with regulatory, payer, and facility guidelines
- Maintain productivity and quality standards in a remote environment
For more details contact at sthakur@navitashealth.com
About Navitas Healthcare, LLC certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.