Job Summary We are seeking an experienced Registered Nurse (RN) with a strong background in Utilization Management, Case Management, and discharge planning within an acute care setting. This is a long-term opportunity for candidates located in California or Nevada. Employee will review patient admissions for appropriateness of care, efficient resource utilization, and compliance with payer requirements. Responsibilities include analyzing medical records, applying InterQual and Milliman criteria, coordinating with interdisciplinary teams, and ensuring accurate clinical documentation.

Qualifications

• Graduation from an accredited school of nursing
• Five (5) years of acute hospital clinical nursing experience, One (1) year of which was in Utilization Management, Case Management, or Clinical Documentation Improvement.
• Minimum three (3) years of Utilization Management experience.
• Minimum of three (3) year's experience with discharge planning in an acute care facility.
• Recent documented experience with InterQual, and ability to pass the InterQual exam.
• Recent documented experience with Milliman experience.

Licensing/Certification Requirements:

• Valid license by the State of Nevada to practice as a Registered Nurse.
• Candidates residing in California may be considered if eligible for Nevada licensure
• Employer may assist with Nevada licensing costs for qualified candidates

AE & Associates, LLC is an Equal Employment Opportunity employer. AE & Associates, LLC prohibits any form of unlawful harassment or discrimination against applicants for employment or employees on the basis of race, color, religion, ancestry, sex, gender identity, gender expression, pregnancy, national origin, age, marital status, familial status, military/veteran status, disability status, genetic information with respect to the applicant or employee, sexual orientation, or any other classification/characteristic protected by applicable federal, state or local law. Pay: $65.00 - $75.00 per hour Work Location: Remote