Nursing Role
3 weeks ago
We are seeking a skilled RN to join our team as a Utilization Review Specialist. This role is responsible for reviewing medical records and determining the necessity of treatments and services.
Responsibilities:The ideal candidate will have 3 years of clinical experience in hospital or urgent care settings, with knowledge of ICD10, CPT, and HCPC coding systems. Familiarity with HMO, PPO, and POS plans is also required.
Requirements:- RN license in California
- 3 years of clinical experience in hospital or urgent care
- Utilization review experience
- Knowledge of ICD10, CPT, and HCPC
- Familiarity with HMO, PPO, and POS plans
- Managed care experience
- Knowledge of medical management process
- Knowledge of NCQA regulations
$95,000 - $125,000 per year, depending on experience.
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