Interim Referral Nurse (Remote)

Position Overview

Join The Healthcare Initiative as an Interim Referral Nurse (Remote) in California. In this role you will review and verify authorizations and supporting documentation for eligibility, codes, and clinical notes. You will obtain required information from various internal and external sources, evaluate orders against established medical guidelines, and either approve, defer, or escalate them to the Medical Director. You are expected to monitor deferrals and escalated requests to ensure timely responses and create standardized communications regarding approvals, modifications, or deferrals. Note: This is a 3–4-month interim assignment. Remote work is available, and candidates must be current residents of California for the duration of the assignment.

Key Responsibilities

• Review and verify authorizations and supporting documentation for eligibility, codes, and clinical notes.
• Obtain required documentation and information from various internal and external sources.
• Evaluate orders to determine if they meet established medical guidelines.
• Approve, defer, or escalate orders to the Medical Director for review.
• Monitor deferrals and escalated requests to ensure timely responses.
• Generate and distribute communications such as denials, approvals with modifications, and deferral letters using standard templates.

Required Qualifications

• Bachelor’s degree in nursing (required)
• Unrestricted California Registered Nurse license (required)
• 2+ years clinical experience in an acute care setting (ER/ICU/Med-Surg or PCU) (required)
• Strong clinical nursing skills following California’s Scope of Practice guidelines (required)
• Strong conflict resolution skills, utilizing tact and diplomacy (required)

Preferred Qualifications

• Working knowledge of Medi-Cal and/or Medicare populations
• General knowledge of NCQA Standards for referrals and authorizations

Benefits & Perks

• Compensation: $50.00 per hour, depending on experience
• Remote work opportunity
• West coast location with opportunities to explore outdoor areas
• Centrally located near a renowned university, sporting events, museums, and exceptional dining