Job title: Utilization Management (Remote) California License in Long Beach, CA at Morgan Stephens Company: Morgan Stephens Job description : Job Title: Care Review Clinician II (RN or LVN) – Remote Location: Remote (Must have active CA license and be available during Pacific Standard Time hours) Pay Rate: Up to $45/hour Job Type: Temp-to-Perm About the Role: A leading Managed Care Organization is seeking an experienced and detail-oriented Care Review Clinician II (RN or LVN) to join their Utilization Management team. This remote position plays a key role in reviewing clinical service requests, supporting continuity of care, and ensuring appropriate, cost-effective healthcare decisions are made in compliance with regulatory and clinical guidelines. Key Responsibilities: Perform clinical reviews of service requests including concurrent and prior authorization determinations Serve as clinical support to the Continuity of Care (COC) and Community Support teams Determine whether requests meet COC or community support criteria and escalate for MD review when needed Conduct provider outreach as appropriate to support authorizations and care coordination Utilize InterQual and other clinical guidelines to assess medical necessity and appropriate length of stay Ensure documentation meets compliance, quality, and turnaround standards Create and manage authorizations in accordance with established UM processes Participate in team meetings and collaborate with other departments to support member care Required Qualifications: Active, unrestricted LVN or RN license in California 3–5 years of clinical experience (inpatient, outpatient, or hospital setting strongly preferred) Prior experience in Utilization Management, Concurrent Review, or Prior Authorization Strong analytical and critical thinking skills in a fast-paced, metric-driven environment Solid computer proficiency, including ability to toggle between multiple databases and tools Experience using InterQual or similar medical necessity criteria tools Knowledge of HIPAA and regulatory compliance standards Excellent verbal and written communication skills Preferred Qualifications: Experience in Managed Care, Health Plans, or payer-side healthcare operations Familiarity with NCQA standards Previous case management or care coordination experience Additional Information: Must provide your own secure and quiet workspace for remote work Equipment (laptop, monitors, etc.) will be provided by the organization Must be available to work 8-hour shifts during PST business hours, Monday–Friday Expected salary : $45 per hour Location : Long Beach, CA Apply for the job now! Apply for this job