Utilization Review RN
Torrance, CA
RadHealth+
5x8 hrs, Days
Referral Bonus

Role: RN Utilization Review (Remote)
Location: Torrance, CA
Shift: Day 5x8-Hour (08:00 - 16:30)
Pay: 50$/Hr

Job Description

Laptop, keyboard and mouse will be provided by the facility
MUST have CA license

We are seeking a detail-oriented and analytical Registered Nurse (RN) to join our Utilization Review team. In this role, you will evaluate the appropriateness, necessity, and efficiency of healthcare services, ensuring patient care aligns with established clinical guidelines, regulatory standards, and payer requirements.

Key Roles and Responsibilities
 

Clinical Reviews: Conduct admission, continued stay, and discharge reviews using evidence-based criteria (e.g., InterQual or MCG) to determine medical necessity.

Care Coordination: Collaborate with physicians, case managers, and multidisciplinary healthcare teams to facilitate efficient patient throughput and discharge planning.

Compliance & Documentation: Maintain accurate, timely documentation of review outcomes, payer communications, and denials management to ensure regulatory compliance.

Payer Liaison: Serve as a primary point of contact for insurance companies and managed care organizations to secure timely authorizations and address concurrent review inquiries.

Documents Required
Updated resume
RN license
Bls Certificate  
Driving License
Covid Card
2 Supervisory References
Skills Checklist