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Pediatric Registered Nurse - RN

Job Description

RN Pediatric Nurse

A rapidly growing Managed Care office is looking for an experienced Registered Nurse with Pediatric experience.

This nurse will need a working knowledge of CCS (California Children's Services).  

They must have some understanding of Utilization Review / Case Management and the Managed Care setting.

They will need to possess good communication skill with Doctors, Nurses, and Insurance Companies.  

This is facility is willing to train!  Please contact for more details!

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Job Requirements

Knowledge of:

  • DRG and ICD-9 and CPT coding, requirements for prior approval.
  • Available community resources.
  • Local Referral Network
  • Effective charting practices and guidelines.
  • Reimbursement related to Medicare, Medi-Cal & Managed Care
  • California Nursing License (RN)


Case Manager  Impatient Utilization Review Utilization Management Discharge Planning CCM Certified Case Manager Ambulatory Clinical Hospital Chart Review INTERQUAL  Milliman DRG ICD Prior Auth Manage Care Complex Telephonic  Quality Supervisor Manager Director Charge ER Emergency Room Auditing  Grievance and Appeals Care Planning Plan of Care Care Management  Concurrent Review


Job Snapshot

Employment Type Full-Time
Job Type Health Care, Nurse, Insurance
Education Not Specified
Experience Not Specified
Manages Others No
Industry Managed Care, Healthcare - Health Services, Insurance
Required Travel None
Job ID 15A*
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Pediatric Registered Nurse - RN

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