On-Call Registered Nurse

LSMA Management Inc • San Bernardino, CA

10d • Remote

About The Position

The On-Call Registered Nurse (RN) is a California-licensed registered nurse responsible for providing after-hours medical management coverage when the Medical Management office is closed. The role supports utilization management (UM), care coordination, discharge processing, and urgent authorization activities, ensuring continuity of care, appropriate utilization of services, and compliance with applicable federal, state, accreditation, and health plan requirements within a healthcare MSO environment.

Requirements

• Graduated from an accredited Registered Nursing program.
• One year of clinical experience as a Registered Nurse.
• Current state Registered Nursing license.
• Knowledge of utilization management principles, medical necessity determination, and regulatory requirements relevant to managed care.
• Familiarity with Milliman Care Guidelines, CMS requirements, NCQA standards, and delegated UM workflows.
• Basic understanding of ICD-10, CPT, and HCPCS coding.
• Strong clinical judgment, critical thinking, and problem-solving skills within RN scope of practice.
• Effective verbal and written communication skills, including professional interaction with physicians and clinical leadership.
• Ability to independently prioritize and manage multiple urgent tasks during on-call hours.
• Proficiency with electronic medical records, utilization management platforms, and Microsoft Office applications.

Nice To Haves

• Bachelor of Science in Nursing (BSN)
• One to two years of experience in utilization management, case management, discharge planning, MSO/IPA, or health plan settings.

Responsibilities

• Provide after-hours medical management coverage when the Medical Management office is closed.
• Support utilization management (UM).
• Support care coordination.
• Support discharge processing.
• Support urgent authorization activities.
• Ensure continuity of care.
• Ensure appropriate utilization of services.
• Ensure compliance with applicable federal, state, accreditation, and health plan requirements within a healthcare MSO environment.

What This Job Offers

• Career Level: Mid Level
• Education Level: Associate degree