Utilization Review Nurse

6 days ago


San Francisco, California, United States Vivo HealthStaff Full time
Job Title: Utilization Review RN

Vivo HealthStaff is seeking a skilled Utilization Review RN to join our team in San Francisco. This hybrid position requires 1-2 days of on-site work per week.

Job Summary:

We are looking for a highly motivated and detail-oriented RN to collaborate with our healthcare team to ensure effective patient outcomes. The ideal candidate will have experience in acute care settings and possess strong communication and problem-solving skills.

Responsibilities:
  • Conduct concurrent and retrospective medical record reviews to determine medical necessity and ensure effective resource utilization.
  • Collaborate with physicians, nurse case managers, and social workers to develop individualized patient plans.
  • Communicate with third-party payers to obtain authorization and resolve denials.
  • Identify and implement strategies to avoid denials and ensure timely payment for services.
  • Provide education and support to healthcare team members on utilization review and management best practices.
Requirements:
  • Valid RN license in the State of California.
  • Bachelor's degree in Nursing.
  • Clinical experience in acute care settings required.
  • Experience with InterQual and Milliman preferred.
Preferred Qualifications:
  • CPR/BLS certification.
  • CCM certification.
  • ACMA certification.
What We Offer:

Vivo HealthStaff is committed to providing a supportive and collaborative work environment. We offer competitive compensation and benefits packages, as well as opportunities for professional growth and development.



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