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Utilization Management - Registered Nurse (RN) (Desk Job)

Managed Care Resources
Details
Location: CA - Hollywood Job Type: Health Care
Nurse
Insurance
Base Pay: N/A Required Education: 2 Year Degree
Bonus: Required Experience: At least 2 year(s)
Other: Required Travel: None
Employee Type: Full-Time Relocation Covered: No
Industry Managed Care, Healthcare - Health Services, Insurance

Job ID: 18A*

Description

The Utilization Management Nurse is responsible for the organization of utilization management services to members and medical providers.

    • Utilization Management Nurse
    • InterQual intensity of service, severity of illness or similar utilization management tools (Milliman)
    • 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 or where to find such rules
    • Acute hospital inpatient utilization review experience.


Requirements
  1. RN California Nursing license
  2. 2 or more years of recent Utilization Review/Case Management experience
  3. Medicare and MediCal Utilization Management knowledge. 
  4. Managed Care experience a plus. 
  5. Excellent organizational skills.
  6. Strong telephonic skills for reviews.
  7. Ability to successfully work with various levels of professional staff
  8. Must be able to work independently and as part of a team.


About the Agency:
Managed Care Resources, Making Careers is a Health Care Staffing Agency in the niche fields of Case Management, Utilization Management / Review, Quality Management / Assurance and Performance Improvement. MCR, Making Careers has been servicing the State of California since 1987 providing Medical Professionals to Hospitals, Medical Groups, IPAs, Health Plans, Healthcare Foundations, Home Health Departments, Medical Offices, Managed Care and Insurance Companies in search of both Permanent and Temporary Staff. Call: (310)-470-4232 or (800)-350-1471 for more information!