Registered Nurse – Utilization Review RNUR26-06087

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 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)

• 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

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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.