Remote Utilization Management Review Nurse

Job is Expired
Location: California
Compensation: Salary
Staff Reviewed: Fri, Jan 21, 2022
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
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