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Utilization Management Nurse

Posted 4 months ago

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💎 Seniority level: Middle, 3 years

📍 Location: Arcadia, CA, PST, NOT STATED

💸 Salary: 40 - 40 USD per hour

🔍 Industry: Managed care

🗣️ Languages: English

⏳ Experience: 3 years

🪄 Skills: LeadershipProject ManagementData AnalysisPeople ManagementProject CoordinationCross-functional Team LeadershipOperations ManagementCommunication SkillsAnalytical SkillsCollaborationMicrosoft Excel

Requirements:
  • Bachelor's degree from a four-year college and/or a professional certification preferred.
  • Minimum 3 years of referrals and utilization management experience.
  • HMO experience is preferred.
  • General knowledge of medical terminology and coding (ICD-10, CPT/HCPCS).
  • Strong verbal and written communication skills.
  • Time management skills.
  • Computer literacy, specifically in Word, Outlook, and Excel.
Responsibilities:
  • Responsible for regional care management programs (inpatient and ambulatory).
  • Ensure care management activities meet regulatory requirements and are efficient and effective.
  • Supervise Nurse Reviewers, including their training, performance evaluation, and scheduling.
  • Support compliance in processing referrals and ensure adherence to policies.
  • Participate in quality improvement initiatives by analyzing processes.
  • Communicate relevant issues and maintain professional relationships with health plans and providers.
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