Utilization Management Nurse
40 - 40 USD per hour
Location:Arcadia, CA, PST, NOT STATED
Languages:English
Seniority level:Middle, 3 years
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.
