Remote Managed Care Payer California Licensed Registered Nurse

Job is Expired
Location: Nationwide
Compensation: Hourly
Staff Reviewed: Tue, Sep 21, 2021

Job Summary

A healthcare and operational efficiency focused consultancy is searching for a person to fill their position for a Remote Managed Care Payer California Licensed Registered Nurse.

Core Responsibilities Include:

  • Performing concurrent reviews of inpatient claims
  • Performing prior authorization reviews for outpatient services
  • Following and maintaining compliance with CMS requirements

Qualifications Include:

  • Current unencumbered RN license in California
  • 2+ Utilization management experience with a health insurance company (managed care/payer experience required)
  • UM for Medicare Advantage, Managed Medicaid, Dual SNP Lines of Business, on the payer side
  • 5+ years of acute clinical experience
  • Proficiency using Milliman Care Guidelines (MCG) and/ or InterQual criteria
  • The ability to effect change, perform critical analyses, promote positive outcomes, and facilitate empowerment for members/families

COMPLETE JOB DESCRIPTION

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