| Location | Fairfield, CA |
Talent4Health is seeking a travel nurse RN Utilization Review for a travel nursing job in Fairfield, California.
Requirements:
• Shift: REMOTE Days | Mon–Fri | 8:00 AM – 4:30 PM
• BSN required
• Active California RN License
• Magnet ANCC-recognized Case Management certification (CCM, ACM-NBCM, etc.)
• Minimum 5 years of clinical nursing experience
• Minimum 3 years of Utilization Review/Case Management experience
• Cerner experience
• Understanding of MCG and Utilization Review requirements for concurrent and initial reviews
• Utilization review, Case management, Performance improvement
• Managed care reimbursement
• Milliman Care Guidelines (MCG)
• Knowledge of Medicare, Medicaid, managed care, payer, and healthcare financial requirements
• EMR navigation and UR documentation tools
• Proficiency in Cerner, Adobe, and Microsoft Office Suite (Excel, Teams, Outlook, PowerPoint, Word)
Important Notes:
• Candidate must provide their own equipment for chart reviews
• Performs inpatient and observation utilization reviews
• Reviews medical necessity using clinical documentation, evidence-based guidelines, and payer requirements
• Collaborates with physicians, revenue cycle, and healthcare teams
• Prepares clinical summaries for payer communications and peer-to-peer reviews
• Participates in audits and quality improvement initiatives
Referral Bonus $250-$500 [Each referral] Medical and other Benefits. Apply Now!!!
A leader and innovator, offering comprehensive talent solutions for the healthcare industry across the nation. Talent4Health, based in Wilmington, DE is a one stop solution that offers access to an inclusive network of excellent healthcare professionals through its state-of-the-art recruitment strategies and extensive career opportunities. We have successfully placed over 3000 plus clinicians with the topmost healthcare facilities across 50 states in the US.
With countless prestigious clients under our umbrella, backed up by passionate and hard-working recruiters, we are a team you have been looking for!
Why Choose us?
When it comes to choosing a recruitment agency, it’s imperative to consider what all they have to offer.
If this is all that excites you, do visit http://www.talent4health.com today!