UM Review NurseDepartment: HS - UM
Employment Type: Full Time
Location: 600 City Parkway West 10th Floor, Orange, CA 92868
Reporting To: Brenda Fresnares
Compensation: $34.00 - $47.00 / hour
DescriptionIn this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans.
This is a remote position for CA-licensed nurses. Candidates must live in California.
We are seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced setting.What You'll Do- Complete prior authorization/retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment
- Refer cases to Medical Directors as needed/appropriate
- Maintain knowledge of state and federal regulations and accreditation standards
- Comply with internal policies and procedures
- Perform any other job duties as requested
Qualifications- Active and unrestricted LVN license in CA.
- At least 1 years of outpatient UM experience
- Experience with Microsoft applications such as Word, Excel, and Outlook
You'll be Great for this Role If: - At least two (2) years of health plan, IPA or MSO experience
- Strong interpersonal skills
- Ability to collaborate with co-workers, senior leadership, and other management
- Experience educating and training staff
Environmental Job Requirements and Working Conditions- This is a remote position. Our office is located at 1600 Corporate Center Drive in Monterey Park, CA. Candidates who live within a 30 mile radius of the office may be expected to work hybrid.
- The schedule is M-F 8 A - 5 P.
- The national target pay range for this role is $34.00 - $47.00 per hour. Actual compensation will be based on job level, geographic location (current or future), experience, and other job-related factors.
Additional Information:The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
