Job Summary
A professional services firm specializing in IT, healthcare, and accounting is searching for a person to fill their position for a Remote Licensed Managed Care UM Nurse in Cerritos.
Core Responsibilities of this position include:
- Performing concurrent reviews of inpatient claims
- Following and maintaining compliance with CMS requirements
- Determining medical appropriateness of inpatient and outpatient services
Required Skills:
- Current unencumbered RN license in California
- 2+ UM experience with a health insurance company, managed care/payer experience
- UM for Medicare Advantage, Managed Medicaid, Dual SNP Lines of Business
- 5+ years of acute clinical experience
- Proficiency using Milliman Care Guidelines (MCG) and/ or InterQual criteria