Utilization Review Specialist

About the Role

We are seeking a detail-oriented and experienced RN or LVN with an active license to join our team as a Utilization Review Nurse . In this role, you will conduct retrospective reviews of inpatient and outpatient claims to ensure medical necessity, compliance, and timely processing within a managed care environment.

Key Responsibilities

• Perform comprehensive utilization reviews for inpatient and outpatient claims.
• Prepare medical records for review by medical directors and provide clinical recommendations.
• Ensure compliance with managed care authorization requirements and organizational policies.
• Communicate effectively with providers, internal teams, and payers to resolve discrepancies.
• Accurately document all review activities in the system.

Required Qualifications

• Active RN or LVN license.
• 3–5 years of experience in utilization management or managed care authorization.
• Strong attention to detail and excellent verbal/written communication skills.
• Familiarity with inpatient/outpatient claims and productivity standards.

Preferred Skills

• EZCap experience (preferred for faster onboarding; transitioning to custom system “Ria”).
• Coding knowledge : ICD-10 and CPT (CPC certification highly desirable).
• Strong written communication and analytical skills.

Position: Utilization Review Nurse

Work Environment: Hybrid (onsite & remote)

Schedule: Full-time, Monday–Friday, flexible start between 7:00–8:00 AM, 8-hour shifts, no weekends

Pay Range: $35–$50/hour (commensurate with experience)

• Contract Type: 6-month contract with potential for permanent hire

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.