Utilization Management Nurse (RN)

Title : Nurse RN 3 (Utilization Management Nurse (RN )

Location if not remote : Rancho Cordova CA (HYBRID)

Travel Required? If so please elaborate.

YES May be asked to come to their assigned home office as needed.

Duration : 6 months contract to hire role

Shift : 8 AM - 5 PM PST

Required Skills :

• Must have California RN License
• Must have Strong Clinical Background with a minimum of 5 years of prior relevant experience doing direct patient care.
• Must have Strong communication and computer navigation skills office/Excel
• UM experience with knowledge of MCG Criteria - Nice to have
• ER and/or ICU experience - Nice to have
• Medicare experience - Nice to have

Disqualifiers/ Dislikes on Resumes:

No Clinical experience. Many Short-term Jobs without explanation. Poor Computer Skills

Summary : The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned to members based on an alpha split and then review clinical information provided by facilities to determine medical necessity when our members admit. You will also be involved with discharge planning and transfers as needed for higher levels of care or out of network admissions.