Utilization Review Registered Nurse

Overview (About Client) Our client, a provider of Health, Dental, Vision, Medicaid and Medicare Healthcare service plans in the state of California with 4.7 million members and $22.9 billion of annual revenues, seeks an accomplished Registered Nurse (Utilization Review – Remote, California Residents Only). Job Title: Registered Nurse (Utilization Review – Remote, California Residents Only) Location: 100% Remote (Must reside in California) Duration: 6+ months (potential to extend or convert to FTE) Pay Rate: $45.00 – $52.00/hour (W2) Schedule:

• Monday–Friday, 8:00 AM – 4:30/5:00 PM (depending on lunch break)

Must-Have Requirements:

• Current, valid California RN license (BSN preferred but not required)
• Strong clinical (hands-on) nursing background
• Strong computer skills with ability to work remotely in a self-directed environment
• Proficiency in Microsoft Office; EMR/chart handling experience a plus

Job Description: The Utilization Review Registered Nurse will review all levels of care for medical necessity, applying clinical knowledge, professional judgment, and MCG guidelines. The nurse will render approval decisions within regulatory turnaround times or escalate to the in-house physician for further review if unable to approve. This role does not involve direct interaction with members; instead, the nurse collaborates with case managers and medical staff at healthcare facilities. Responsibilities:

• Review medical necessity for all levels of care in alignment with MCG guidelines
• Make approval determinations or escalate cases to in-house MD when required
• Ensure compliance with regulatory turnaround times
• Collaborate with case managers and medical staff at facilities (no direct member contact)

Minimum Qualifications:

• California RN license in good standing
• Strong hands-on clinical nursing experience

Additional Qualifications:

• Proficiency in Microsoft Office applications
• Experience with EMR/chart handling

Preferred Qualifications:

• BSN degree
• Previous utilization review or case management experience

Recruiter Contact Info Sajag Bhardwaj Email: [email protected] www.ameritconsulting.com I'd love to talk to you if you think this position is right up your alley, and assure prompt communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you. Company Overview: Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally; as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients’ businesses forward. Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws. Apply tot his job Apply To this Job