Acute Care, Analysis Skills, Case Management, Clinical Medicine, Clinical Practices/Protocols, Clinical Study Publications, Communication Skills, Discharge Plans, Documentation, 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 nursing experience preferred
- Experience in Utilization Review, Case Management, or similar role preferred
- Strong understanding of medical necessity, payer guidelines, and clinical documentation
- Knowledge of insurance authorization processes preferred
- Strong analytical, communication, and decision-making skills
- Ability to work independently in a remote environment
- Proficiency with EMR systems preferred (Epic experience a plus)
Job Responsibilities
- Perform utilization review of inpatient and outpatient cases
- Evaluate medical necessity based on clinical guidelines and payer policies
- Review patient records and documentation for appropriate level of care
- Collaborate with physicians, case managers, and insurance providers
- Process prior authorizations and continued stay reviews
- Document all review decisions accurately in EMR systems
- Identify cases requiring further clinical escalation
- Ensure compliance with regulatory, hospital, and insurance standards
- Support discharge planning and care coordination as needed
- Maintain productivity and quality standards in a remote setting
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.