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RN-Registered Nurse-Care Review Clinician III / RN

Job Description

Job Summary

Works with the Utilization Management team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review and other utilization management activities aimed at providing  ealthcare members with the right care at the right place at the right time.  Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review.  Mentors and trains new team members.  Assesses services forMembers to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Essential Functions
• Provides concurrent review and prior authorizations (as needed) according to  policy for members as part of the Utilization Management team.
• Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures.
• Assist with leadership responsibility in collaboration with the Supervisor of Utilization Management as required.
• Provides training and mentoring to Utilization Management staff as appropriate.
• Participates in interdepartmental integration and collaboration to enhance the continuity of care for  members including Behavioral Health and Long Term Care.
• Maintains department productivity and quality measures.

Job Requirements

RN Licensure
Utilization Review/Case Management experience


Abe Ghebrehiwet
Senior Account Executive
Nurse Resolutions
888.411.2228. X 204 Toll Free
407.982.7508. Fax
[Click Here to Email Your Resumé]

Job Snapshot

Contact Name Abe Ghebrehiwet
Contact Phone 888-411-2228 X204
Post Date 10/15/2014
Location Long Beach, CA
Employment Type Full-Time
Job Type Health Care, Nurse, Insurance
Education 4 Year Degree
Experience At least 2 year(s)
Manages Others No
Industry Healthcare - Health Services, Managed Care, Insurance
Required Travel Not Specified
Job ID abe
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