Talentify
Utilization Review (Prior Auth) RN *Remote*
This job is now closed
Job Description
- Req#: JP-004318906
Employer Industry: Healthcare Services
Why Consider this Job Opportunity:
- Opportunity for career advancement and growth within the organization
- Competitive pay based on experience
- Benefits package including health insurance and retirement savings options
- Chance to make a positive impact on patient care and outcomes
- Supportive and collaborative work environment
What to Expect (Job Responsibilities):
- Coordinate continuing care/outside services for value-based risk members
- Monitor patients in Skilled Nursing Facilities and out-of-network admissions
- Screen for appropriateness of care and establish stability for transfer
- Coordinate post-hospitalization treatment plans and evaluate effectiveness
- Collaborate with the healthcare team for quality improvement
What is Required (Qualifications):
- California RN License
- BLS AHA Certification
- Five or more (5+) years of clinical experience
- Three to five (3-5) years of Utilization Management experience
- One to three (1-3) years of recent care management prior authorization experience
How to Stand Out (Preferred Qualifications):
- Graduate of an accredited school of nursing
- Experience working with health plan auditors
- Working knowledge of InterQual
- Knowledgeable of NCQA and ICE standards
#HealthcareServices #CareManagement #UtilizationReview #Nursing #CareerOpportunity
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