California Licensed Utilization Management Nurse

A company is looking for a Nurse RN. Key Responsibilities Perform utilization reviews and first-level determination approvals using evidence-based guidelines Conduct clinical reviews of claims for medical necessity and ensure compliance with medical policies Prepare cases for the Medical Director and maintain quality and productivity metrics for casework Required Qualifications Associate's degree in nursing required; bachelor's degree preferred Active Registered Nurse (RN) license in good standing Minimum of 5 years of relevant clinical experience in a hospital setting Strong clinical background with demonstrated critical thinking skills Proficiency with Windows and Excel

Created: 2026-03-05