Remote Senior Registered Nurse Reviewer in Los Angeles

This job has been removed

Location: California

Compensation: To Be Discussed

Staff Reviewed: Thu, Jul 15, 2021

This job expires in: 13 days

Job Category: Healthcare

Remote Level: 100% Remote

Weekly Hours: Full Time

Employer Type: Employer

Career Level: Experienced

Education Level: Bachelors

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

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