Utilization Management Nurse (RN) Job at Pacer Group, Rancho Cordova, CA

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  • Pacer Group
  • Rancho Cordova, CA

Job Description

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

Job Tags

Contract work, Local area,

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