Job Summary
A health insurance company is searching for a person to fill their position for a Remote Senior Registered Nurse Reviewer in Los Angeles.
Core Responsibilities Include:
- Collaborating with healthcare providers and members
- Managing reviews of all levels of complexity, only requiring guidance on new issues where standards have not been developed
- Conducting initial medical necessity clinical screening and determining if initial clinical information meets criteria
Qualifications for this position include:
- Requires an AS/BS in nursing from an accredited institution
- Current unrestricted RN license in applicable state(s) required
- Requires knowledge of Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care
- 3 years of clinical nursing experience in an ambulatory or hospital setting
- 3 years of prior utilization, medical management and/or quality management and/or call center experience; or any combination
