California Licensed Utilization Review Nurse
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Job Summary
Utilizing clinical judgment to assess outpatient medical services, the California Licensed Utilization Review Nurse will work remotely to approve or deny services based on Medical Necessity Criteria, requiring at least one year of outpatient Utilization Management experience.
Key responsibilities
- Complete prior authorization and retrospective reviews for various medical services and equipment
- Refer cases to Medical Directors as necessary and maintain knowledge of regulations and standards
- Comply with internal policies and perform additional duties as requested
Required qualifications
- Active and unrestricted LVN or RN license in California
- Experience with Microsoft applications such as Word, Excel, and Outlook
- Two years of health plan, IPA, or MSO experience preferred
- Strong interpersonal skills and ability to collaborate effectively
- Experience in educating and training staff is a plus
Complete Job Description
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