California Licensed Utilization Management Nurse
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Job Summary
To ensure compliance with regulatory requirements and meet member needs, the full-time California Licensed Utilization Management Nurse will conduct prospective and concurrent/retrospective reviews of referrals while working remotely.
Key responsibilities
- Perform prospective and concurrent/retrospective reviews of referrals to ensure compliance with nationally recognized UM criteria
- Document UM referral reviews accurately and manage a caseload efficiently
- Collaborate with healthcare providers to ensure appropriate citation of criteria in member correspondence
Required qualifications
- Active, unrestricted Registered Nurse (RN) license issued by the California BRN
- A minimum of two years of direct clinical patient care experience in an acute care facility
- Experience in an HMO or Managed Care setting preferred
- High school diploma or GED required; Bachelor's degree in nursing preferred
- Strong knowledge of nationally recognized UM criteria and relevant regulatory requirements
Complete Job Description
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