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

emanatehealth.us

Base: $52.03 - $80.64; bonus/equity: not specified...
Not specified
Three years utilization management experience
California rn license required
Computer proficiency required
Emanate Health is seeking a Utilization Review Nurse with a minimum of three years of experience in utilization management and a California RN license. The role involves evaluating medical records for medical necessity and documenting decisions while providing support for medical claims and utilization practices

Job Summary

  • The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and appropriate policies.
  • Emanate Health was named the #1 ranked health care system in the United States on Glassdoor's list of Best Places to Work in 2021.
  • The role involves documenting decisions using protocol sets, reviewing medical claims, and referring cases to Medical Directors as needed.

Matching Summary

Match Score: 85

Emanate Health is seeking a Utilization Review Nurse with a minimum of three years of experience in utilization management and a California RN license. The role involves evaluating medical records for medical necessity and documenting decisions while providing support for medical claims and utilization practices.

Salary

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

Skills & Requirements

Must-have

  • Three years utilization management experience
  • California RN license required
  • Computer proficiency required

Nice-to-have

  • Experience in quality-related job preferred
  • Excellent customer service skills required
  • Part of a team strengthening communities

Key Requirements

  • Minimum three years of utilization management experience
  • California RN license
  • Computer proficiency

Work Rights

Not specified

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