California RN Utilization Review

Job Summary

A company is looking for an RN Utilization Review.

Key Responsibilities

• Review medical records for appropriate admission status and continued hospitalization
• Collaborate with healthcare professionals to implement denial prevention strategies and obtain inpatient authorizations
• Document interactions with Patient Access to verify correct payer sources for patient stays

Required Qualifications and Education

• Minimum two years of acute hospital clinical experience or a Master's degree in Case Management or Nursing field in lieu of one year of experience
• California RN license
• AHA BLS certification
• Ability to pass annual Inter-rater reliability test for Utilization Review products
• Knowledge of managed care and payer environment preferred