Job Summary

A nonprofit organization needs applicants for an opening for a Remote Utilization Management Review Nurse .

Core Responsibilities of this position include:

• Reviewing authorization requests/claims documentation within specified timeframes
• Validating the medical appropriateness and coding accuracy of services rendered
• Utilizing appropriate resources to guide review decisions and document decisions clearly and concisely

Must meet the following requirements for consideration:

• A valid California license as a Registered Nurse or Licensed Vocational Nurse
• Five (5) years clinical nursing experience
• Clear, concise, and professional written and verbal communication skills
• Knowledge of computer applications, including proficiency in Microsoft Office Suite
• Knowledge of San Mateo County provider community and community resources
• Knowledge of Medicare and Medi-Cal coverage requirements and regulatory guidelines