Remote Registered Nurse Utilization Management – California
- Location
-
United States
Not Provided
Job Description
Are you a Registered Nurse with Utilization Management experience looking to get your foot in the door with a large Health Care organization? We have an amazing remote opportunity available. You need to have either lived in California previously or currently reside there, and during that period, gained experience in Utilization Management.
Your day will consist of:
Clinical review for members receiving care in an inpatient setting. Reviews the appropriateness and medical necessity of admissions and continuing inpatient confinement utilizing clinical guidelines and Medicaid criteria. Makes first level approval determinations and appropriately refers cases to the Medical Director for second review when case does not meet criteria.
You will do great in this position with the following:
- Strong knowledge of acute chronic care nursing principles, methods and common treatments
- Strong knowledge of common human diseases and usual and customary methods of treatments
- Demonstrated knowledge of medical terminology; • Knowledge of acute hospital organization and interrelationships of various clinical and diagnostic services
- Ability to assess and judge the clinical performance of physicians and other health professionals
- Knowledge of ICD10 and/or CPT coding
- Ability to effectively evaluate medical records to determine appropriateness and necessity of care
- Demonstrated knowledge of health care delivery systems
- Registered Nurse with an active, current, unrestricted license
- Minimum of two years (2) full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management
- Experience working with patients and caregivers regarding self-care and disease management required
- Experience working in case management or care coordination is a plus; • Experience with MCG Clinical guidelines, Medi-cal, and California Children’s Services
Job Type: Full-time
Pay: $40.50 – $50.72 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Work Location: Remote
Advice from our career coach
As a Registered Nurse with Utilization Management experience looking to land a remote position with a large Health Care organization, it's crucial to highlight your expertise in clinical review, medical necessity assessments, and case referral procedures. To stand out as an applicant, showcase your knowledge of acute chronic care nursing principles, ICD10/CPT coding, and experience in case management or care coordination. Make sure to emphasize your active, unrestricted RN license, minimum 2 years of clinical experience, and familiarity with MCG Clinical guidelines, Medi-cal, and California Children’s Services. Additionally, demonstrate your ability to evaluate medical records effectively and communicate with patients and caregivers regarding self-care and disease management.
- Highlight your expertise in clinical review, medical necessity assessments, and case referral procedures
- Showcase your knowledge of acute chronic care nursing principles and ICD10/CPT coding
- Emphasize your active, unrestricted RN license and minimum of 2 years clinical experience
- Demonstrate familiarity with MCG Clinical guidelines, Medi-cal, and California Children’s Services
- Illustrate your communication skills with patients and caregivers regarding self-care and disease management
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About the job
United States
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