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Utilization Management RN

The Judge Group El Cerrito Full-Time
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Judge Healthcare is currently seeking a Utilization Management RN in Corona, CA!

This job will have the following responsibilities:
  • Be the hand-off from health plans as they contact our members to determine whether they were impacted by incorrect UM practices. 
  • Pull UM cases done in CORE to verify that the appropriate UM process and program is being applied
Qualifications & Requirements:
  • Must have 2-year Utilization Management knowledge and experience with the evaluation of clinical situations in concert with the member’s health plan, contractual obligations, member’s benefits, nationally recognized standards of care, evidence based criteria, and applicable state and federal regulations and guidelines, including those set forth by Medicare and Medi-Cal. 
  • Strong computer literacy skills and working experience with Microsoft applications, i.e. Word, Excel. 
  • Good verbal and written communication skills; ability to communicate effectively with members, physicians and other health care professionals in a professional, courteous and customer driven manner.
 

Skills required

Utilization Management
Managed Care
Nursing Home Care
Registered Nurse
Disease Management
Hospitalization

Location

Salary Estimator

Based on Job Title, Location and Skills
$130K
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Job ID: 581313

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The Judge Group is a privately owned, leading professional services firm with nearly 50 years of experience in providing technology, talent, and learning solutions. Our services are successfully delivered through a network of more than 35 offices in the United States, Canada, and India. The Judge Group serves more than 47 Fortune 100 companies and is responsible for 7,000 professionals on assignment annually across a wide range of industries.

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