Remote Utilization Management Nurse (Pre-Service Review – RN or LVN) Must have CALIFORNIA license.

Job Type: Full-timeSchedule: Tuesday - Saturday OR Sunday - Thursday 8:00 AM – 5:00 PM (PST)Location: Anywhere in the US,Remote (California RN or LVN license required)Job SummaryMUST HAVE CALIFORNIA LICENSE. We are seeking a detail-oriented Utilization Management Nurse (Pre-Service / Prior Authorization Review) to join our growing clinical team. This role focuses on reviewing pre-certification requests for inpatient and outpatient services, ensuring patients receive the right care at the right time.You’ll collaborate with providers, case managers, and medical directors to support high-quality, bolthires-effective care delivery. This position is fully remote, but requires an active California RN or LVN license. Responsibilities• Review pre-service authorization (prior auth) requests for medical necessity using evidence-based guidelines (MCG, InterQual, or similar). • Collaborate with providers, physicians, and medical directors on care determinations. • Verify eligibility, benefits, and accuracy of submitted medical codes (ICD-10, CPT).• Process requests within required turnaround times while documenting all activities accurately. • Support appeals and grievances by providing clinical input when needed. • Maintain professional communication with providers, patients, and internal staff. • Assist with single-service agreements when services are out of network. • Participate in team calls, case discussions, and process improvement initiatives. QualificationsRequired:• Active, unrestricted California LVN or RN license. • 1+ year of experience with Medicare or Medicaid.• Familiarity with utilization management, medical terminology, and coding. Preferred (not required):• 2+ years of experience in a managed care or hospital setting. • Prior use of Milliman (MCG), InterQual, or CMS guidelines. • Knowledge of Medicare Managed Care Plans. • Associates or Bachelor’s degree in Nursing. • Certification such as CPHQ, ABQAURP, or Six Sigma. • Strong critical thinking and problem-solving skills. • Excellent written and verbal communication. • Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment.• Proficiency in bolthires Word, Excel, and Outlook. What We Offer• 100% remote position with a flexible schedule (Mon - Fri) or (Wed - Sun)• Competitive salary and performance-based incentives. • Full benefits package, including:• Medical, dental, and vision coverage. • 401(k) with employer contributions. • Paid time off, personal days, and holidays. • Life and disability insurance. • Ongoing training and career development. Job Type: Full-timePay: $90,000.00 - $100,000.00 per yearBenefits:• 401(k)• 401(k) matching• Dental insurance• Disability insurance• Employee assistance program• Employee discount• Flexible schedule• Flexible spending account• Health insurance• Health savings account• Life insurance• Paid time off• Parental leave• Professional development assistance• Referral program• Retirement plan• Travel reimbursement• Vision insuranceExperience:• MCG Guidelines: 1 year (Preferred)• Utilization Management Pre-Service: 1 year (Required)• Utilization management with a Managed Care Plan: 1 year (Required)• CMS Guidelines: 1 year (Preferred)• Medicare Advantage: 1 year (Preferred)License/Certification:• CALIFORNIA RN or LVN License (Required)Work Location:Remote Apply tot his job