California RN/LVN Utilization Management Nurse

Job Summary

A company is looking for a Utilization Management Nurse - Pre-Service (LVN or RN, active California license required).

Key Responsibilities

• Review pre-certification requests for medical necessity and refer to medical director as needed
• Utilize CMS and Milliman Care Guidelines to assist in referral determinations
• Maintain established turnaround time goals for referral processing

Required Qualifications

• Minimum of 3 years nursing experience in a clinical setting
• At least 1 year of pre-service Utilization Management experience
• 1 year of experience in managed care (Medicaid and/or Medicare)
• Active, valid, and unrestricted LVN or RN license in California
• High School Diploma or GED; preferred Associates or Bachelor's degree in Nursing