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Position: Utilization Review Nurse

Work Enviroment: Hybrid work schedule

Schedule: Full time position, Flexible start time of 7-8 am, 5 days x 8hrs , no weekends, Monday - Friday

Pay Rate: $35-$50/hr (Based on experience)

Contract to Hire: 6 month contract with opportunity for permament hire position after contract

Job Description:

We are seeking to hire an experienced RN or LVN with an active license to help address claims retro review. This role focuses on reviewing inpatient and outpatient claims for medical necessity and compliance, ensuring timely and accurate processing in a managed care environment.

Key Responsibilities:

+ Perform detailed utilization reviews for inpatient and outpatient claims.

+ Prepare medical records for medical directors and provide recommendations based on clinical review.

+ Ensure compliance with managed care authorization requirements and organizational policies.

+ Communicate effectively with providers, internal teams, and payers to resolve issues.

+ Document all review activities accurately in the system.

Required Qualifications:

+ Active RN or LVN license. Must have 3-5 years of experience.

+ Experience in managed care authorization and utilization management.

+ Strong attention to detail and excellent communication skills.

+ Familiarity with inpatient/outpatient claims and productivity standards.

Preferred Skills:

+ EZCap experience (a plus for faster onboarding; process will transition to a custom system called “Ria”).

+ Coding Experience ICD -10 and CPT (CPC certification preferred).

+ Strong written communication skills.

Productivity Metric for the Role:

+ 5 professional/outpatient reviews per hour

+ 3 inpatient reviews per hour

Training period: 2 weeks.

Additional Skills & Qualifications

Familiarity with inpatient/outpatient claims, productivity, strong written communication, and coding knowledge (CPC cert) is a plus. Experience with "ez cap" software is a plus for faster training, but not mandatory as the process will transition to a custom system called "Ria.". Candidates will prep medical records for medical directors and provide recommendations based on clinical review.

Experience Level

Intermediate Level

Job Type & Location

This is a Contract position based out of Canoga Park, CA 91304.

Pay and Benefits

The pay range for this position is $35.00 - $50.00/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

• Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a hybrid position in Canoga Park,CA 91304.

Application Deadline

This position is anticipated to close on Nov 28, 2025.

h4>About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

About TEKsystems and TEKsystems Global Services

We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.