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
...roleideal for someone who thrives in a hands-on, people-facing environment. This is a hybrid position, with the flexibility to work from home when not visiting client sites. This is not a traditional office job. It combines customer service, relationship-building, and...
...We are looking for a Senior Medicaid Care Management Systems & Data Analyst (MES / CRMS) Location: Hybrid - Richmond, VA Experience Required: 12+ Years Note: Only Local Candidates within a 2-3 hour drive Description:- Important to note bf submitting...
CLEANROOM PACKAGING OPERATOR Location: Palo Alto, CA Reports to: Operations Manager Shift : Days Compensation: $19 - $23/hr Weve built our reputation as an industry leader by delivering world-class precision metal finishing solutions for over 50 years. We...
...Salisbury, MD Shift: Rotational Pay Range: $29.00 $46.00/hr Sign-On Bonus: Up to $20,000 Relocation Assistance: Up to $2,500 Job Summary: Pride Health is seeking a Medical Laboratory Scientist/Technician to perform, evaluate, and...
...The Junior Brand Manager supports the companys mission by managing the e-commerce process specific to Amazon marketplace, including but not limited to forecasting, inventory management, analyzing data and pricing, user experience and monitoring sales. This is a great...