Precision Technologies
Overview
Utilization Management (UM) Nurse – California License (Remote) Location: Remote – Must have active California RN License Start Date: ASAP Job Type: Contract or Full-Time We are hiring a Remote Utilization Management (UM) Nurse with an active California RN license to join our growing team. This non-patient-facing role is focused on reviewing clinical records, assessing medical necessity, and providing care recommendations using established clinical guidelines. The role supports effective, patient-centered care across the continuum by driving high-quality, cost-efficient healthcare outcomes.
Responsibilities
Conduct prospective, retrospective, or concurrent medical necessity reviews for assigned members.
Apply appropriate clinical criteria such as Medicare, Medi-Cal, MCG, InterQual, Milliman, or health plan-specific guidelines.
Partner with the Medical Director to ensure the quality and accuracy of adverse determination notices.
Support discharge planning and communicate timely updates to transition-of-care teams.
Focus on outpatient utilization management (not inpatient hospital).
Maintain and exceed productivity and quality benchmarks.
Serve as a clinical resource for non-clinical team members when needed.
Qualifications
Required:
Active, unrestricted RN license in the State of California
Associate’s Degree in Nursing (ADN) – Required; BSN preferred
2+ years of experience in medical management or utilization review
Strong knowledge of MCG, InterQual, and NCQA standards
Familiarity with Medicare and Medi-Cal guidelines
Experience in outpatient utilization review or case management
Ability to work independently in a remote environment with high attention to detail
Strong communication and documentation skills
Preferred:
Prior experience with managed care organizations or health plans
Knowledge of EMR systems and digital case management tools
Position Details
100% Remote – Must work within the U.S. and hold a California RN license
Standard business hours (PST preferred, but flexible)
For more details, please reach us at sridevi@precisiontechcorp.com
#J-18808-Ljbffr
Utilization Management (UM) Nurse – California License (Remote) Location: Remote – Must have active California RN License Start Date: ASAP Job Type: Contract or Full-Time We are hiring a Remote Utilization Management (UM) Nurse with an active California RN license to join our growing team. This non-patient-facing role is focused on reviewing clinical records, assessing medical necessity, and providing care recommendations using established clinical guidelines. The role supports effective, patient-centered care across the continuum by driving high-quality, cost-efficient healthcare outcomes.
Responsibilities
Conduct prospective, retrospective, or concurrent medical necessity reviews for assigned members.
Apply appropriate clinical criteria such as Medicare, Medi-Cal, MCG, InterQual, Milliman, or health plan-specific guidelines.
Partner with the Medical Director to ensure the quality and accuracy of adverse determination notices.
Support discharge planning and communicate timely updates to transition-of-care teams.
Focus on outpatient utilization management (not inpatient hospital).
Maintain and exceed productivity and quality benchmarks.
Serve as a clinical resource for non-clinical team members when needed.
Qualifications
Required:
Active, unrestricted RN license in the State of California
Associate’s Degree in Nursing (ADN) – Required; BSN preferred
2+ years of experience in medical management or utilization review
Strong knowledge of MCG, InterQual, and NCQA standards
Familiarity with Medicare and Medi-Cal guidelines
Experience in outpatient utilization review or case management
Ability to work independently in a remote environment with high attention to detail
Strong communication and documentation skills
Preferred:
Prior experience with managed care organizations or health plans
Knowledge of EMR systems and digital case management tools
Position Details
100% Remote – Must work within the U.S. and hold a California RN license
Standard business hours (PST preferred, but flexible)
For more details, please reach us at sridevi@precisiontechcorp.com
#J-18808-Ljbffr