California RN Medical Management Clinician

Job Summary

A company is looking for an RN Medical Management Clinician to fill a remote opening with a managed care organization.

Key Responsibilities

• Manage complex cases and evaluate multiple variables against guidelines
• Serve as a resource for lower-level clinicians and assist in process improvement initiatives
• Assess and apply medical policies and clinical guidelines within the scope of licensure

Required Qualifications

• High School/GED/BSN required
• RN license in the state of residence
• 6 years of clinical and/or utilization review experience, including 1 year in managed care organization (MCO)
• Experience in outpatient review, including pre-authorization and clinical guidelines
• Strong computer skills and ability to work from home with necessary technology