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Sco Um Review Rn Jobs (NOW HIRING)

Oregon Health & Science University

Specifically, the UM Nurse does the following: * Reviews pre-admissions for correct classification ... Current, unencumbered Oregon State Registered Nurse License * BLS from AHA required. New hires will ...

Oregon Health & Science University

Specifically, the UM Nurse does the following: * Reviews pre-admissions for correct classification ... Current, unencumbered Oregon State Registered Nurse License * BLS from AHA required. New hires will ...

Oregon Health & Science University

Utilization Review- RN

$55.24 - $92.02/hr

Specifically, the UM Nurse does the following: * Reviews pre-admissions for correct classification ... Current, unencumbered Oregon State Registered Nurse License * BLS from AHA required. New hires will ...

CommonSpirit Health

Ensures UM Physicians are provided the relevant information needed to accurately review a referral ... Clear and current CA Registered Nurse (RN) license * Ability to demonstrate leadership and ...

OU Health (Parent)

Utilization Review RN

Whittier, CA

$2.8K/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 ...

Oregon Health & Science University

Specifically, the UM Nurse does the following: * Reviews pre-admissions for correct classification ... Current, unencumbered Oregon State Registered Nurse License * BLS from AHA required. New hires will ...

Oregon Health & Science University

Specifically, the UM Nurse does the following: * Reviews pre-admissions for correct classification ... Current, unencumbered Oregon State Registered Nurse License * BLS from AHA required. New hires will ...

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

As of Jun 22, 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 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 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 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 June 2026, with employment types broken down into 100% As Needed. Highlights an 95% Physical, 3% Hybrid, and 2% Remote job distribution, with an average salary of $92,525 per year, or $44.5 per hour.

Clinical Review Nurse - Prior Authorization

Akido

Chino, CA

Other

Posted 24 days ago

Job description

The Opportunity

  • The Clinical Review Nurse - Prior Authorization is responsible for reviewing and processing prior authorization requests to ensure medical necessity, appropriate level of care, and compliance with health plan and regulatory requirements. This role focuses exclusively on prior authorization activities within the Utilization Management (UM) department and supports delegated UM operations in a California managed care environment. The Clinical Review Nurse works closely with providers, Medical Directors, and operational teams to ensure timely and accurate authorization determinations in accordance with established clinical guidelines and delegation standards.

What you'll do

  • Review and process prior authorizations for outpatient services, procedures, diagnostic testing, specialty referrals, and DME and ancillary services
  • Evaluate requests using MCG guidelines and health plan criteria and policies
  • Review medical records and supporting clinical documentation to ensure completeness, accuracy, and medical necessity in accordance with established clinical guidelines and health plan requirements.
  • Identify missing or insufficient documentation and coordinate with providers for additional information 
  • Ensure all clinical determinations are properly documented in the system 
  • Maintain compliance with DMHC prior authorization requirements, CMS guidelines, health plan delegation standards, turnaround times, notification requirements, and documentation standards
  • Communicate with physicians, medical groups, facilities, and ancillary providers to obtain additional clinical information and provide authorization status updates as needed
  • Identify cases requiring clinical review and prepare clinical summaries for Medical Director determination
  • Ensure cases requiring denial are routed appropriately to the Medical Director
  • Document all authorization activities accurately within EZCap, maintaining detailed notes, status updates, and decision rationale
  • Collaborate with UM Coordinators, Claims, Eligibility, and Operations

Who you are

  • Active California LVN or RN license 
  • 3-5+ years of current clinical UM review
  • Experience with prior authorization in managed care or delegated environment
  • Knowledge of MCG criteria, medical necessity review, and prior authorization workflows
  • Experience with EZCap (preferred)
  • Experience in a delegated MSO or health plan environment (preferred)
  • Knowledge of California managed care regulations (DMHC/CMS)
  • Strong clinical assessment skills and attention to detail
  • Effective written and verbal communication
  • Ability to manage competing priorities in a fast-pace environment

Apply