Rn - Quality Assurance/utilization Review - Business Development - Full Time 8hr

Citrus Valley Health Partners

Covina, US
Base: $52.03 - $80.64; bonus/equity: not specified...
Evaluate medical records
Determine medical necessity
Apply clinical acumen
The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and the appropriate application of policies and guidelines to urgent and standard reviews

Job Summary

  • The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and the appropriate application of policies and guidelines to urgent and standard reviews.
  • You will document decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices.
  • When you join Emanate Health, you become part of a team that works together to strengthen our communities and grow as individuals.

Matching Summary

The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and the appropriate application of policies and guidelines to urgent and standard reviews.

Salary

Base: $52.03 - $80.64; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • evaluate medical records
  • determine medical necessity
  • apply clinical acumen
  • urgent and standard reviews
  • document decisions
  • medical claims review

Nice-to-have

  • strengthen communities
  • grow as individuals
  • world-class healthcare delivery

Key Requirements

  • Minimum of three years of utilization management experience
  • California RN license
  • Computer proficiency required
  • Excellent customer service skills required

Work Rights

Not specified

Tailored Resume

Cover Letter