Um Prior Authorization Review Nurse - Rn

Uclahealth

Los Angeles, CA, United States
$65.53 - 84.75 hourly; not specified; not specifie...
On-site
Clinical review of prior authorization requests
Apply clinical guidelines and protocols
Communicate with providers for clarification
The UM Review Nurse evaluates clinical documentation for prior authorization requests to determine medical necessity and benefit eligibility

Job Summary

  • The UM Review Nurse evaluates clinical documentation for prior authorization requests to determine medical necessity and benefit eligibility.
  • Key responsibilities include conducting clinical reviews, applying established guidelines, coordinating escalations, and communicating with providers.
  • This role requires a BSN/MSN, California RN license, and proficiency in evidence-based medical necessity criteria and computer skills.

Matching Summary

The UM Review Nurse evaluates clinical documentation for prior authorization requests to determine medical necessity and benefit eligibility.

Salary

$65.53 - 84.75 Hourly; Not specified; Not specified

Skills & Requirements

Must-have

  • Clinical review of prior authorization requests
  • Apply clinical guidelines and protocols
  • Communicate with providers for clarification
  • Ensure compliance with standards
  • Document review findings in system

Nice-to-have

  • Resourceful and diplomatic communication
  • Creative problem-solving skills
  • Identify process improvement opportunities

Key Requirements

  • BSN and/or MSN required
  • Current California RN license required
  • Minimum three years of experience in utilization management preferred
  • Proficient computer skills required

Work Rights

Not specified

Tailored Resume

Cover Letter