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Sco Um Review Rn Jobs (NOW HIRING)

OU Health (Parent)

Utilization Review RN

Whittier, CA · On-site

$2.80K/wk

Details Client Name PIH HEALTH Job Type Travel Offering Nursing Profession Registered Nurse Specialty Utilization Review Job ID 18027156 Job Title Utilization Review RN Weekly Pay $2800.0 Shift ...

OU Health (Parent)

Utilization Review RN

Whittier, CA

$2.80K/wk

Details Client Name PIH HEALTH Job Type Travel Offering Nursing Profession Registered Nurse Specialty Utilization Review Job ID 18027156 Job Title Utilization Review RN Weekly Pay $2800.0 Shift ...

CommonSpirit Health

Ensures UM Physicians are provided the relevant information needed to accurately review a referral ... (RN) license - Ability to demonstrate leadership and management skills - Knowledge of all ...

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How much do sco um review rn jobs pay per hour?

As of May 31, 2026, the average hourly pay for sco um review rn in the United States is $44.48, according to ZipRecruiter salary data. Most workers in this role earn between $33.65 and $51.92 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a SCO UM Review RN, and why are they important?

To thrive as a SCO UM Review RN (Senior Care Options Utilization Management Review Registered Nurse), you need a valid RN license, strong clinical assessment skills, and a solid understanding of medical necessity criteria for managed care populations. Familiarity with utilization management software, InterQual or Milliman guidelines, and electronic health records is typically required. Exceptional attention to detail, critical thinking, and effective communication are vital soft skills for collaborating with care teams and advocating for patient needs. These skills ensure accurate review processes, regulatory compliance, and optimized patient outcomes in managed care environments.

What are some common challenges faced by a SCO UM Review RN and how can they be managed effectively?

A SCO UM Review RN often faces challenges such as balancing a high volume of case reviews with the need for thorough, accurate assessments and staying updated with frequently changing regulatory requirements. Time management and strong organizational skills are crucial for managing daily responsibilities, which typically include reviewing medical records, collaborating with interdisciplinary teams, and communicating with providers and members. Building strong relationships with both clinical and non-clinical staff can help streamline workflows, while ongoing professional development ensures you remain current with best practices and compliance standards.

What are SCO UM Review RNs?

SCO UM Review RNs are registered nurses who specialize in Utilization Management (UM) review for Senior Care Options (SCO) programs. They evaluate medical records, treatment plans, and healthcare services to ensure that care provided to elderly patients is medically necessary and meets health plan guidelines. These nurses play a key role in coordinating care, preventing unnecessary services, and advocating for appropriate patient care within managed care organizations.

What is the difference between Sco Um Review Rn vs Licensed Practical Nurse?

AspectSco Um Review RnLicensed Practical Nurse
CredentialsRegistered Nurse (RN) license, possibly specialized certificationsLicensed Practical Nurse (LPN) license
Work EnvironmentHospitals, clinics, outpatient facilities, often in more complex care settingsLong-term care, nursing homes, clinics, with more routine patient care
Job ResponsibilitiesAssessments, care planning, complex patient care, medication administrationBasic patient care, vital signs, assisting RNs and physicians

Both Sco Um Review Rn and Licensed Practical Nurse roles involve patient care, but Sco Um Review Rn typically requires a higher level of education and certification, allowing for more complex responsibilities. LPNs focus on routine patient care and support roles. The choice depends on your career goals and desired scope of practice.

More about Sco Um Review Rn jobs
What states have the most Sco Um Review Rn jobs? States with the most job openings for Sco Um Review Rn jobs include:
What job categories do people searching Sco Um Review Rn jobs look for? The top searched job categories for Sco Um Review Rn jobs are:
Sco Um Review Rn jobs near you
Infographic showing various Sco Um Review Rn job openings in the United States as of May 2026, with employment types broken down into 2% As Needed, 88% Full Time, 7% Part Time, and 3% Contract. Highlights an 1% Physical, and 99% Remote job distribution, with an average salary of $92,525 per year, or $44.5 per hour.

UM Review Nurse - LVN

Astrana Health, Inc.

Monterey Park, CA • On-site

$34 - $47/hr

Full-time

Posted 12 days ago

Job description

UM Review Nurse - LVN
Department: HS - UM
Employment Type: Full Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Phillip Vasquez
Compensation: $34.00 - $47.00 / hour
Description
Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans.
This position requires open availability between Monday through Sunday, 8 A - 8 P. You would be scheduled for 5 shifts per week. This is a remote position for CA-licensed nurses. Candidates must live in California.
We are seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced setting.
Our Values:
  • Put Patients First
  • Empower Entrepreneurial Provider and Care Teams
  • Operate with Integrity & Excellence
  • Be Innovative
  • Work As One Team

What You'll Do
  • Complete prior authorization/retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment
  • Refer cases to Medical Directors as needed/appropriate
  • Maintain knowledge of state and federal regulations and accreditation standards
  • Comply with internal policies and procedures
  • Perform any other job duties as requested

Qualifications
  • Active and unrestricted LVN license in CA.
  • 1+ years of outpatient UM experience
  • Experience with Microsoft applications such as Word, Excel, and Outlook

You'll be Great for this Role If:
  • Two (2) years of health plan, IPA or MSO experience
  • Strong interpersonal skills
  • Ability to collaborate with co-workers, senior leadership, and other management
  • Experience educating and training staff

Environmental Job Requirements and Working Conditions
  • This is a remote position. Our office is located at 1600 Corporate Center Drive in Monterey Park, CA. Candidates who live within a 30 mile radius of the office may be expected to work hybrid.
  • Typical business hours are Monday - Friday from 8:30 AM to 5 PM, however, this position requires open availability between 8 AM - 8 PM PST, M-Su. Your schedule will be compromised of 5 shifts per week. Nurses rotate weekend and holiday coverage. Overtime is required in this position.
  • The national target pay range for this role is $34.00 - $47.00 per hour. Actual compensation will be based on job level, geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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