Pacer Staffing is seeking experienced Utilization Management Nurses to join a leading healthcare organization supporting Medicare members. This is a Contract-to-Hire role with long-term potential and strong team collaboration.
Position Details:
• Location: Hybrid – California (Must be local & available onsite as needed)
• Schedule: Mon–Fri, 8 AM – 5 PM PST
• Duration: 6+ months with potential extension & conversion
• Max Pay Rate: $53/hr (W2 pay available)
• Start Date: November 2025
• Department: Utilization Management / Clinical Operations
Key Responsibilities:
• Perform prospective, concurrent, and retrospective utilization reviews
• Apply CMS and nationally recognized clinical criteria to determine medical necessity
• Support discharge planning and post-acute care coordination
• Conduct clinical review of claims for compliance and coding accuracy
• Present cases to Medical Directors for determinations
• Maintain productivity and compliance standards
• Collaborate with Case Management, Behavioral Health, Prior Auth, and Intake teams
Required Qualifications:
• Active RN license
• Minimum 5+ years direct patient care experience
• Excellent communication, documentation & computer navigation skills
• Strong clinical judgment and critical thinking
Preferred Experience:
• UM/UR experience with MCG
• ER and/or ICU background
• Medicare experience
• Bachelor’s Degree in Nursing (preferred)
Work Environment:
• Team size: 12
• Standard laptop and tools provided
• Occasional onsite meetings required
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