California Licensed Nurse RN

A company is looking for a Nurse RN 3 to review medical necessity for various levels of care.

Key Responsibilities

Evaluate medical necessity across different care levels using clinical expertise and established guidelines

Make approval decisions or escalate cases to the in-house physician when further review is required

Ensure timely completion of decision-making processes in compliance with regulatory requirements

Collaborate effectively with case managers and medical staff at facilities

Required Qualifications

Current valid CA RN license required; BSN is preferred

Demonstrated hands-on clinical experience

Proficient computer skills with the ability to navigate essential software and EMR systems

Proven capacity to work remotely and manage tasks independently