Utilization Management Nurse, Senior
2 weeks ago
Your Role
The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information provided by the facilities to determine medical necessity when our members admit. You will also be involved with discharge planning and transfers as needed for higher levels of care or out of network admissions.
Your Knowledge and Experience
- Bachelors of Science in Nursing or advanced degree preferred.
- Requires a current California RN License
- Requires at least 5 years of prior relevant experience
- Requires strong communication and computer navigation skills
- Desires strong teamwork and collaboration skills
- Requires independent motivation and strong work ethic
- Requires strong critical thinking skills
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San Francisco, CA, United States Clinical Management Consultants Full timeThe Utilization Management Nurse Director opportunity delivers a leadership launchpad in a dynamic Bay Area hospital, uniting mission-driven care with performance excellence and innovation. The Utilization Management Nurse Director will step into a high-visibility role shaping patient flow, value-based care, and quality outcomes. The Utilization Management...
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