A healthcare company is in need of a Telecommute Case Manager Registered Nurse. Core Responsibilities of this position include: Applying or interpreting of applicable criteria and clinical guidelines Using a holistic approach, consulting with clinical colleagues, supervisors, medical directors
Associate’s Degree or higher. 2+ year’s experience in either insurance or hospital UM or appeal experience. Strong acute Utilization Review experience. Experience with Milliman (MCG) or InterQual. RN licensure- Licensed to work California and Nevada payors.