Remote California Licensed Lead Utilization Management Nurse

Location: California

Compensation: To Be Discussed

Staff Reviewed: Wed, Feb 10, 2021

This job expires in: 12 days

Job Category: Healthcare

Remote Level: 100% Remote

Weekly Hours: Full Time

Employer Type: Employer

Career Level: Experienced

Job Summary

A healthcare company is filling a position for a Remote California Licensed Lead Utilization Management Nurse.

Core Responsibilities Include:

  • Manage general, preauthorization and/or retrospective review of outpatient services
  • Determine medical appropriateness and medical necessity for a variety of services
  • Work with providers to meet the health care needs of members with the appropriate resources

Required Skills:

  • Graduate of an approved nursing program
  • A current, unrestricted California RN or LVN/LPN license
  • 3+ years of experience clinical experience in an acute care facility
  • OR equivalent combination of education and experience
  • Payor experience and/or experience with nationally recognized clinical criteria, including MCG

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