RN Utilization Manager (Hybrid)

Job Title: RN Utilization Management (Hybrid)
Location: Palm Springs, CA
Employment Type: Direct Hire
Schedule: M-F - 8AM-5PM
Salary: $123,968/yr
Overview:
We're hiring an RN Referrals Manager/Utilization Management Referrals Manager to lead a high-volume referrals department. This is a newly established leadership role supporting referral processing, regulatory compliance, and performance management, with 11 direct reports plus offshore referral coordinators.
Key Responsibilities for RN Utilization Management:

• Provide daily oversight of the Referral Department (workflow, quality, turnaround times)
• Ensure compliance with applicable regulatory and health plan requirements
• Coach, train, and develop staff; monitor productivity and performance trends
• Support audits (CMS/DMHC/DHCS/Health Plan) and corrective action plans
• Serve as the clinical resource for referral processing and peer-to-peer coordination
• Partner with medical leadership and senior directors to improve processes and documentation

Required Qualifications for RN Utilization Management:

• Active California RN license
• Bachelor's Degree in Nursing (BSN) required (Master's preferred)
• 3+ years RN experience in Utilization Review/Compliance Review/Acute Care/ER
• 3+ years in a Supervisory/Managerial role
• Strong knowledge of clinical criteria and documentation standards; familiarity with diagnosis/procedure coding practices

100% Paid Benefits:

• Medical insurance at no cost to employee (employer covered)
• No-cost pharmacy benefit (employee)
• Dental, Vision, EAP, Life/AD&D, LTD options
• 401(k) with company match; PTO (released after 90-day evaluation)

Referral Bonus (MediQuest):
Referrals really pay off. Do you know someone in healthcare looking for work? Refer them to MediQuest and earn up to $500 per referral, depending on the type of position they accept.

• No limit to the number of referrals you provide or the amount you can earn
• Anyone can earn a referral bonus - not just MediQuest candidates

About MediQuest:
MediQuest matches high-quality healthcare professionals with talented medical support staff. Our dedicated medical focus and expertise allow us to build collaborative partnerships with both clients and candidates, ultimately creating lasting value and delivering performance-based results in the constantly evolving healthcare industry. We have been connecting candidates with private practices, outpatient clinics, hospitals, independent physicians' associations, medical billing services, urgent care, and healthcare administration since 1965. We know that it takes great people to make a great company.PandoLogic. Keywords: Utilization Review Nurse, Location: Palm Springs, CA - 92263