Registered Nurse – Utilization Review - RNUR26-06087

Location: Santa Rosa, CA

Orientation: 40 Hours (Non-Billable)

• Active Registered Nurse (RN) License required
• Minimum 1–2 years acute care nursing experience preferred
• Experience in Utilization Review, Case Management, or similar role preferred
• Strong understanding of medical necessity, payer guidelines, and clinical documentation
• Knowledge of insurance authorization processes preferred
• Strong analytical, communication, and decision-making skills
• Ability to work independently in a remote environment
• Proficiency with EMR systems preferred (Epic experience a plus)

• Perform utilization review of inpatient and outpatient cases
• Evaluate medical necessity based on clinical guidelines and payer policies
• Review patient records and documentation for appropriate level of care
• Collaborate with physicians, case managers, and insurance providers
• Process prior authorizations and continued stay reviews
• Document all review decisions accurately in EMR systems
• Identify cases requiring further clinical escalation
• Ensure compliance with regulatory, hospital, and insurance standards
• Support discharge planning and care coordination as needed
• Maintain productivity and quality standards in a remote setting

For more details contact at sthakur@navitashealth.com

We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.