UM Nurse, RN

2 weeks ago

Rancho Cucamonga, CA, United States IEHP Full time

2 days ago Be among the first 25 applicants

Overview

Under the general direction of the Utilization Management Manager, the Utilization Management Nurse is responsible for prospective and concurrent/retrospective review of referrals ensuring regulatory requirements are being met as they relate to language readability and appropriate citation of criteria in Member correspondence. This position is responsible to ensure meeting Members needs using nationally recognized UM criteria.

What you can expect

Find joy in serving others with IEHP We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience.

Commitment to Quality

The IEHP Team is committed to incorporating IEHPs Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks
  • Competitive salary
  • Telecommute schedule
  • State of the art fitness center on-site
  • Medical Insurance with Dental and Vision
  • Life, short-term, and long-term disability options
  • Career advancement opportunities and professional development
  • Wellness programs that promote a healthy work-life balance
  • Flexible Spending Account Health Care/Childcare
  • CalPERS retirement
  • 457(b) option with a contribution match
  • Paid life insurance for employees
  • Pet care insurance
Education & Requirements
  • Two (2) or more years of utilization management experience in a health care delivery setting specifically in prior authorization or two (2) or more years of experience in an acute care facility
  • Experience in an HMO or experience in a Managed Care setting preferred
  • High school diploma or GED required
  • Bachelor's degree in Nursing from an accredited institution preferred
  • Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
Key Qualifications
  • Must have a valid California Drivers license
  • Knowledge of Title 22, Title 10, DMHC, DHCS, and CMS regulatory requirements specifically as they relate to UM/Health Plan correspondence.
  • Exhibits a high attention to detail in documenting UM referral reviews
  • Ability to work at a high level of speed while maintaining accuracy
  • Ability to work well with both physician and nursing staff
Pay Range
  • $91,249.60 USD Annually - $120,910.40 USD Annually
Seniority level
  • Entry level
Employment type
  • Full-time
Job function
  • Health Care Provider
Industries
  • Hospitals and Health Care

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