California Licensed Utilization Nurse

Job Summary

A company is looking for a Utilization Management Nurse.

Key Responsibilities

• Conduct initial reviews of prior authorization requests to determine coverage for health benefit plan members
• Collaborate with the Director of Utilization Management to meet operational targets and support medical management initiatives
• Coordinate case management for complex cases and participate in Clinical Rounds with the Chief Medical Officer

Required Qualifications

• Active unrestricted RN license in the State of California
• 3-5 years of experience in a managed care environment
• Experience with pre-authorization and concurrent review processes
• Knowledge of Milliman Care Guidelines (MCG)
• Strong computer skills, including proficiency in Microsoft Office Suite