Job Title: Registered Nurse - Utilization Reviewย
Location: Santa Rosa, CAย
Shift Details: Day Shift | 5x8 Hours | 08:00 AM - 04:30 PM
Contract Duration: 13 Weeks
Orientation: 40 Hours (Non-Billable)
Required Qualifications- Active Registered Nurse (RN) License required
- Minimum 1-2 years acute care experience preferred
- Experience in Utilization Review, Case Management, or similar clinical coordination role preferred
- Strong understanding of medical necessity criteria and payer guidelines
- Knowledge of insurance authorization and review processes
- Strong documentation, analytical, and communication skills
- Ability to work independently in a remote setting
- Experience with EMR systems preferred (Epic preferred)
Job Responsibilities- Perform utilization review for inpatient and outpatient services
- Evaluate medical records for appropriate level of care and medical necessity
- Process prior authorizations and continued stay reviews
- Collaborate with physicians, case managers, and insurance payers
- Document review decisions accurately in EMR systems
- Identify cases requiring escalation to clinical reviewers or medical directors
- Support discharge planning and care coordination when needed
- Ensure compliance with regulatory, payer, and facility guidelines
- Maintain productivity and quality standards in a remote environment
For more details contact atย sthakur@navitashealth.comย
About Navitas Healthcare, LLC certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.