Utilization Review RN (Hybrid)

Job Description

Job Description

Vivo HealthStaff is searching for a Utilization Review RN for a hybrid position for a health plan in San Francisco. It is a hybrid position with 1-2 days per week on-site required.

Collaborates with the physician, nurse case manager, social worker, and other members of the health care team to meet individualized patient outcomes. Performs concurrent, and retrospective medical record reviews based on approved screening criteria, knowledge of insurance coverage, and communication with the third-party payers. Ensures medical necessity determinations, service authorization and concurrent denials are managed effectively and financially responsibly.

Education

Valid RN license in State of California

• Bachelor's degree in Nursing

Experience

Clinical experience in acute care setting Required

Licenses and Certifications

CPR - Cardiac Pulmonary Resuscitation CPR / BLS Preferred and

Knowledge, Skills, and Abilities

Verbal and written communication skills.