<div><b><strong>SNF Review Nurse - LVN or RN (100% Remote)</strong></b><br/><br/> <strong>Job Title:</strong> Skilled Nursing Facility (SNF) Review Nurse (LVN or RN) <br/> <br/> <strong>Location:</strong> 100% Remote (Must hold an active California license) <br/> <br/> <strong>Position Type:</strong> Full-Time Contract (Coverage / Temp-to-Perm Potential) <br/> <br/> <strong>Shift:</strong> Monday - Friday, 8:00 AM - 5:00 PM PST (Standard business hours) <br/> <br/> <strong>Pay Range:</strong> <br/> <ul> <li> <strong>LVN:</strong> $38.00 - $48.08 / hour (DOE) </li> <li> <strong>RN:</strong> $48.08 - $50.48 / hour (DOE) </li> </ul> <br/><br/><b><strong>Role Overview</strong></b><br/> <br/> We are seeking an experienced and detail-oriented <strong>Licensed Vocational Nurse (LVN)</strong> or <strong>Registered Nurse (RN)</strong> to manage end-to-end Utilization Management (UM) and Discharge Planning. In this role, you will conduct daily inpatient reviews, concurrent reviews, and coordinate care across Skilled Nursing Facilities (SNF), Home Health (HH), and Durable Medical Equipment (DME). <br/> <br/> The ideal candidate possesses hands-on expertise navigating <strong>MCG criteria</strong> , writing formal denial letters, applying Medicare/CMS guidelines, and communicating confidently with Medical Directors and physician partners. <br/><br/><b><strong>Key Responsibilities</strong></b><br/> <ul> <li> <strong>End-to-End UM & Care Coordination:</strong> Manage the complete UM lifecycle through Discharge Planning, conducting daily inpatient concurrent reviews for SNF placements, DME, and Home Health care. </li> <li> <strong>Clinical Criteria Application:</strong> Apply <strong>MCG criteria</strong> to evaluate clinical appropriateness, determine care tiers, and write formal, structured denial letters when necessary. </li> <li> <strong>Regulatory Compliance:</strong> Utilize Medicare LCD/NCD guidelines and CMS regulations (including the 2-Midnight Rule) for pre-service authorizations and discharge planning. </li> <li> <strong>Multidisciplinary Communication:</strong> Present clear, concise clinical case summaries during daily multidisciplinary rounds. Confidently engage with Medical Directors, attending physicians, and hospital representatives. </li> <li> <strong>Appeals & Notices:</strong> Handle processes involving QIO, NOMNC, and DENC notices. </li> </ul> <br/><br/><b><strong>Required Qualifications</strong></b><br/> <ul> <li> <strong>Licensure:</strong> Active, unencumbered <strong>California RN or LVN License</strong> . </li> <li> <strong>Clinical Experience:</strong> Direct, hands-on Utilization Management (UM) experience in an <strong>IPA, MSO, Health Plan, or Delegated model</strong> setting. (Inpatient UM experience is required; candidates with only Prior Authorization background will not qualify). </li> <li> <strong>SNF Review Expertise:</strong> Proven experience performing SNF initial, concurrent, and discharge reviews. </li> <li> <strong>MCG Mastery:</strong> True hands-on experience utilizing MCG criteria to drive clinical reviews (not just pull-and-pass). </li> <li> <strong>Regulatory Knowledge:</strong> Deep familiarity with CMS guidelines (SNF, HH, LCD/NCD) and Medicare discharge standards for SNF and Acute Rehab Units (ARU). </li> <li> <strong>Technical Skills:</strong> Proficiency with digital workspace tools, including Microsoft Word, Excel, and PDF workflows. Equipment is provided. </li> </ul> <br/><br/><b><strong>Preferred Qualifications</strong></b><br/> <ul> <li> <strong>5+ years</strong> of concurrent Inpatient Utilization Management experience. </li> <li> Strong background in <strong>Medicare Advantage</strong> or fast-paced Commercial UM environment. </li> <li> Knowledge of complex observation vs. inpatient criteria and strict CMS turnaround timelines. </li> </ul> <br/><br/><b><strong>Candidate Attributes for Success</strong></b><br/> <ul> <li> <strong>Resilient Communicator:</strong> Highly comfortable presenting complex cases to Medical Directors without hesitation. </li> <li> <strong>Thrives in High-Volume Environments:</strong> Ability to maintain high accuracy standards (95%+ audit floor) while managing a standard daily caseload of 25-35 cases. </li> <li> <strong>Fast Learner:</strong> Excellent organizational and note-taking skills, capable of absorbing complex clinical documentation quickly. </li> <li> <strong>Full Workspace Dedication:</strong> Dedicated to working uninterrupted at a desktop/laptop environment during standard business hours. </li> </ul> <br/><br/><b><strong>What We Offer</strong></b><br/> <ul> <li> <strong>100% Fully Remote Work:</strong> Enjoy working from home anywhere in the United States while serving California healthcare programs. </li> <li> <strong>Structured Onboarding:</strong> A supportive 2-week training program complete with compliance, MCG workflow alignment, case-study practice, and direct nurse shadowing before going live. </li> <li> <strong>Comprehensive Benefits:</strong> Eligibility for a full employee benefits package during your contract tenure. </li> <li> <strong>Growth Potential:</strong> While initial placement is a dedicated contract role covering leave, top-performing contractors frequently gain opportunities for temp-to-perm conversion or transition into permanent clinical teams. </li> </ul> <br/><br/></div>