SNF Review Nurse – LVN or RN (100% Remote)
Job Title: Skilled Nursing Facility (SNF) Review Nurse (LVN or RN)
Location: 100% Remote (Must hold an active California license)
Position Type: Full-Time Contract (Coverage / Temp-to-Perm Potential)
Shift: Monday – Friday, 8:00 AM – 5:00 PM PST (Standard business hours)
Pay Range:
- LVN: $38.00 – $48.08 / hour (DOE)
- RN: $48.08 – $50.48 / hour (DOE)
Role Overview
We are seeking an experienced and detail-oriented Licensed Vocational Nurse (LVN) or Registered Nurse (RN) to manage end-to-end Utilization Management (UM) and Discharge Planning. In this role, you will conduct daily inpatient reviews, concurrent reviews, and coordinate care across Skilled Nursing Facilities (SNF), Home Health (HH), and Durable Medical Equipment (DME).
The ideal candidate possesses hands-on expertise navigating MCG criteria, writing formal denial letters, applying Medicare/CMS guidelines, and communicating confidently with Medical Directors and physician partners.
Key Responsibilities
- End-to-End UM & Care Coordination: Manage the complete UM lifecycle through Discharge Planning, conducting daily inpatient concurrent reviews for SNF placements, DME, and Home Health care.
- Clinical Criteria Application: Apply MCG criteria to evaluate clinical appropriateness, determine care tiers, and write formal, structured denial letters when necessary.
- Regulatory Compliance: Utilize Medicare LCD/NCD guidelines and CMS regulations (including the 2-Midnight Rule) for pre-service authorizations and discharge planning.
- Multidisciplinary Communication: Present clear, concise clinical case summaries during daily multidisciplinary rounds. Confidently engage with Medical Directors, attending physicians, and hospital representatives.
- Appeals & Notices: Handle processes involving QIO, NOMNC, and DENC notices.
Required Qualifications
- Licensure: Active, unencumbered California RN or LVN License.
- Clinical Experience: Direct, hands-on Utilization Management (UM) experience in an IPA, MSO, Health Plan, or Delegated model setting. (Inpatient UM experience is required; candidates with only Prior Authorization background will not qualify).
- SNF Review Expertise: Proven experience performing SNF initial, concurrent, and discharge reviews.
- MCG Mastery: True hands-on experience utilizing MCG criteria to drive clinical reviews (not just pull-and-pass).
- Regulatory Knowledge: Deep familiarity with CMS guidelines (SNF, HH, LCD/NCD) and Medicare discharge standards for SNF and Acute Rehab Units (ARU).
- Technical Skills: Proficiency with digital workspace tools, including Microsoft Word, Excel, and PDF workflows. Equipment is provided.
Preferred Qualifications
- 5+ years of concurrent Inpatient Utilization Management experience.
- Strong background in Medicare Advantage or fast-paced Commercial UM environment.
- Knowledge of complex observation vs. inpatient criteria and strict CMS turnaround timelines.
Candidate Attributes for Success
- Resilient Communicator: Highly comfortable presenting complex cases to Medical Directors without hesitation.
- Thrives in High-Volume Environments: Ability to maintain high accuracy standards (95%+ audit floor) while managing a standard daily caseload of 25–35 cases.
- Fast Learner: Excellent organizational and note-taking skills, capable of absorbing complex clinical documentation quickly.
- Full Workspace Dedication: Dedicated to working uninterrupted at a desktop/laptop environment during standard business hours.
What We Offer
- 100% Fully Remote Work: Enjoy working from home anywhere in the United States while serving California healthcare programs.
- Structured Onboarding: A supportive 2-week training program complete with compliance, MCG workflow alignment, case-study practice, and direct nurse shadowing before going live.
- Comprehensive Benefits: Eligibility for a full employee benefits package during your contract tenure.
- Growth Potential: While initial placement is a dedicated contract role covering leave, top-performing contractors frequently gain opportunities for temp-to-perm conversion or transition into permanent clinical teams.
*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
