Registered Nurse – Utilization Review RNUR26-06086

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)

• Active Registered Nurse (RN) License required
• Minimum 12 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)

• 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

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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.