Utilization Management Nurse

2 weeks ago


Fontana, United States A-Line Staffing Full time
NOW HIRING RN Concurrent Review Nurse for a top managed care organization located in California

Be one of the first applicants, read the complete overview of the role below, then send your application for consideration.

*MUST LIVE IN CALIFORNIA. Must be a CA Registered Nurse*

*Hours* - 8am to 5pm, Monday through Friday

*Pay Rate*: $40 to $42 per hour (depending on experience)

*Summary:* Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.

*Job Responsibilities*:
* Perform review of concurrent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director for secondary review.
* Complete medical necessity and level of care reviews for requested services using InterQual guidelines and refer to Medical Directors for review depending on case findings.
* Collaborate with various staff within provider networks and discharge planning team electronically and telephonically to coordinate member care.
* Conduct discharge planning.
* Educate providers on utilization and medical management processes.
* Provide clinical knowledge and act as a clinical resource to non-clinical team staff.
* Enter and maintain pertinent clinical information in various medical management systems.

*REQUIREMENTS*
* California Registered Nurse License (active and in good standing)
* Managed Care experience
* Hospital experience
* Utilization Management
* InterQual reviews

INDSV

Job Type: Full-time

Pay: $40.00 - $42.00 per hour

Benefits:
* 401(k)
* Dental insurance
* Health insurance
* Life insurance
* Vision insurance
Schedule:
* Monday to Friday

License/Certification:
* California RN License (Required)

Location:
* California (Required)

Work Location: Remote

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