Employer Industry: Healthcare Services

Why Consider this Job Opportunity:
- Competitive pay up to [highest pay]
- Opportunity for career advancement and growth within the organization
- Supportive and collaborative work environment
- Chance to make a positive impact on member care and quality outcomes
- Work remotely in a fast-paced and high-stress environment
- Access to specialized experts driving innovation and speed to market

What to Expect (Job Responsibilities):
- Review prior authorization specialty referral requests and acute inpatient admission for appropriate care and setting
- Collaborate with the Regional Medical Director to review member referral history and avoid unnecessary admissions
- Assess, plan, intervene, monitor, evaluate, and document care during acute episodes and prior authorizations
- Communicate effectively with providers, staff, and health plans regarding medical management and referral authorization issues
- Research alternative care plans and assist in routing members to the most appropriate care/setting

What is Required (Qualifications):
- Graduate from an accredited Registered Nursing Program or Licensed Vocational Nursing Program
- Current California Licenses
- Minimum of 1 year acute experience
- Knowledge of NCQA, CMS, HSAG, and health plan requirements related to utilization management
- Knowledgeable in computers and MS Office programs

How to Stand Out (Preferred Qualifications):
- 0-2 years of experience in prior authorization, utilization review, or utilization management
- Experience in dealing with responsibility with confidential matters
- Ability to work in a multi-task, fast-paced, high-stress environment
- Strong communication and interpersonal skills
- Familiarity with DME contracts and equipment utilization

#HealthcareServices #UtilizationManagement #NursingCareer #RemoteWorkOpportunity #CareerGrowth

We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately. We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.