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 :
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.
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