Utilization Management Nurse
- Full-time
A company is looking for a Utilization Management Nurse to review and monitor healthcare service utilization for members.
Key Responsibilities
Conducts concurrent and retrospective reviews of facility and home health services to improve quality outcomes and decrease costs
Determines observational vs acute inpatient status as part of the prior authorization process
Engages with providers for proactive discharge and transition planning and prepares necessary documentation for compliance
Required Qualifications
Minimum 2 years of clinical experience as an RN, LPN, or LVN required
Minimum 1 year of managed care or equivalent health plan experience preferred
Experience in health plan utilization management and facility concurrent review required
Active unrestricted Nursing license required
Experience with InterQual or MCG authorization criteria preferred
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Utilization Management Nurse • Concord, California, United States