California Licensed Utilization Nurse

Job Summary

A company is looking for a Utilization Nurse - Referral & Auth.

Key Responsibilities

• Determine medical necessity for inpatient utilization and assist in discharge planning
• Conduct medical necessity reviews for incoming referrals and claims requests
• Implement utilization management methodologies in collaboration with healthcare providers

Required Qualifications

• 3 to 5 years of nursing experience in a relevant healthcare setting
• Computer proficiency in MS Word, Excel, and MS Office Programs
• Experience with Medicare, Commercial Plans, and Medi-Cal/ACA standards
• 2 to 3 years of utilization management review experience
• Registered Nurse (RN) license in the State of California