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California Licensed UM NurseVirtualVocations • Erie, Pennsylvania, United States
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California Licensed UM Nurse

California Licensed UM Nurse

VirtualVocations • Erie, Pennsylvania, United States
4 days ago
Job type
  • Full-time
Job description
Seeking a California Licensed UM Nurse for a full-time remote position, who will review prior authorization requests for medical necessity, apply CMS and Milliman Care Guidelines, and collaborate with providers to ensure high-quality care, working Sunday through Thursday during Pacific Time hours. Key responsibilities: Review pre-certification requests for medical necessity and refer to medical director when additional expertise is needed Utilize CMS guidelines and Milliman Care Guidelines for referral determinations while maintaining established turnaround times Verify eligibility and benefit coverage, and maintain professional rapport with providers and patients to ensure efficient processing of referrals Required qualifications: Minimum of 3 years nursing experience in a clinical setting At least 1 year of pre-service UM experience in a managed care environment Active, valid, and unrestricted LVN or RN license in California Experience with CMS guidelines and Milliman Care Guidelines High School Diploma or GED; preferred Associates or Bachelor's degree in Nursing
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California Licensed UM Nurse • Erie, Pennsylvania, United States

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