Utilization Management RN – Remote (California Only)

Capital Staffing Solutions is a healthcare staffing firm that places nurses and clinical professionals in temporary and permanent roles, including remote opportunities.

Utilization Management RN – Remote (California Only)Remote | Monday–Friday | Medicare Line of Business We are seeking an experienced Utilization Management Registered Nurse (RN) for a fully remote opportunity supporting a fast-paced Medicare Concurrent Review team. This position is ideal for nurses with a strong inpatient hospital background and prior utilization management/concurrent review experience who are looking to grow within a collaborative and highly respected healthcare organization. Responsibilities • Perform concurrent utilization reviews and determine medical necessity using evidence-based criteria • Apply MCG and/or InterQual guidelines • Review inpatient admissions and continued stays • Present cases to Medical Directors for review and determination • Coordinate discharge planning and transitions of care • Communicate with providers and internal clinical teams • Maintain quality and productivity metrics • Participate in staff meetings, huddles, and clinical rounds • Work within regulatory and CMS guidelines Required Qualifications • Active unrestricted California RN license • Minimum 5 years inpatient hospital bedside nursing experience • Minimum 2 years Utilization Management / Concurrent Review experience • Strong clinical judgment and critical thinking skills • Experience working in fast-paced healthcare environments • Strong computer skills and ability to navigate multiple systems/screens simultaneously • Excellent communication and time management skills • Dedicated HIPAA-compliant remote workspace with reliable internet connection Preferred Qualifications • ICU or ER nursing experience • Medicare utilization management experience • MCG and/or InterQual experience • Case management or discharge planning experience Preferred Clinical Backgrounds • ICU • ER • Med-Surg • Telemetry • Stepdown Schedule • Monday–Friday • 8:00 AM – 5:00 PM PST • Fully Remote (California residents only) Employment Type • Contract with chance to extend or hire • Long-term opportunity with potential for permanent conversion If you are an experienced RN with strong inpatient clinical experience and utilization management background, we encourage you to apply today for immediate consideration. #AJ1 Pay: From $45.00 per hour Benefits: • 401(k) • Dental insurance • Health insurance • Life insurance • Vision insurance Application Question(s): • Do you have ICU or ER Experience? Experience: • Inpatient Hospital Beside nursing: 5 years (Required) • Utilization Management / Concurrent Review: 2 years (Required) License/Certification: • CA RN License (Required) Work Location: Remote