California Licensed RN Care Manager

Job Summary

To ensure high-quality patient care while efficiently utilizing medical resources, the full-time California Licensed RN Care Manager in Utilization Management will review patient medical records, assess treatment appropriateness, and collaborate with healthcare providers and insurance companies in a remote setting.

Key responsibilities

• Completes clinical reviews of acute medical patients using the Optum/Inter Qual tool to determine the appropriateness of care settings and services
• Collaborates with healthcare professionals to develop and implement comprehensive patient care plans, facilitating communication among all stakeholders
• Meets weekly productivity and quality audit metrics while participating in required training and maintaining departmental education standards

Required qualifications

• Associate's Degree in nursing or equivalent combination of education and related experience
• Five years of acute hospital experience, preferably in critical care areas
• Two years of utilization review experience using the Optum/Inter Qual product within the last 12 months
• Registered Nurse (RN) licensure in the state of practice
• Bachelor's Degree in Nursing (BSN) is preferred