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Utilization Management - Registered Nurse - UM RN

Managed Care Resources
Location: CA - Hollywood Job Type: Health Care
Base Pay: N/A Required Education: Not Specified
Bonus: Required Experience: At least 2 year(s)
Other: Required Travel: None
Employee Type: Full-Time Relocation Covered: Not Specified
Industry Healthcare - Health Services, Managed Care, Insurance

Job ID: 06A*

  • Utilization Management Registered Nurse
  • Medicare and MediCal Utilization Management knowledge.
  • InterQual intensity of service, severity of illness or similar utilization management tools (Milliman)
  • Performs pre-admission, concurrent inpatient and retrospective reviews
  • Performs on-site review for acute or SNF member admissions, as needed
  • Length of stay, continued stay review, authorization of services based upon evidence based criteria
  • Discharge planning with attention to Medicare requirements for transition of care planning
  • Utilizing the physician advisor for cases not meeting criteria
  • General knowledge of Medicare, Medicaid/MediCal utilization rules 
  • Acute hospital inpatient utilization review experience
  • Collaborate with case managers

  • RN California Nursing license
  • 3 years of acute hospital experience treating adults in the surgical, critical care or ER department
  • 2 years of recent Utilization Review/Case Management experience
  • Managed care experience desired 
  • Medicare and MediCal Utilization Management knowledge 
  • Excellent organizational skills
  • Strong telephonic skills for reviews
  • Ability to successfully work with various levels of professional staff
  • Must be able to work independently and as part of a team