Utilization Review Nurse (100% REMOTE)

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.

Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Utilization Review Nurse. NOTE- THIS IS 100% REMOTE ROLE & ONLY W2 CANDIDATES/NO C2C/1099 *** Candidate must be authorized to work in USA without requiring sponsorship *** Position: Utilization Review Nurse (Job Id -3146173) Location: Los Angeles CA 90024 (100% REMOTE) Duration: 3 Months + Possible Extension We are seeking an experienced Utilization Management Review Nurse with a strong background in outpatient prior authorization within a health plan or managed care environment. The ideal candidate is a California licensed RN who can independently review clinical documentation, apply evidence based medical necessity criteria, and make sound authorization decisions in a high volume setting.

This role requires confident communication with physicians, payers, and internal teams, strong critical thinking skills, and a solid understanding of Medicare, Medi Cal, and health plan utilization review requirements. The Utilization Management Review Nurse is responsible for the review and evaluation of clinical information and documentation related to prior authorization requests for medical services. Reviews documentation and interprets data obtained from clinical records or systems and uses clinical decision-making to apply appropriate clinical criteria and policies in line with regulatory, accreditation, and departmental requirements. Independently coordinates the clinical resolution with clinician/MD support as required. Acts as a resource for external teams such as customer service and claims. Utilizes advanced practice nursing skills in the assessment, education, and coordination of care for an identified group of patients. Collaborates and consults with the multi-disciplinary team, including but not limited to Physicians, Nursing, Ancillary, Professional, Technical, and other clinical and/or department team members along with patients and families to ensure safe and effective coordination of care. Participates in performance improvement projects/processes and other duties as assigned.