Concurrent Review Nurse 2

Sacramento, CA 95833

Posted: 10/04/2019 Category: Healthcare Job Number: 32689
WHAT YOU' LL DO:
Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations. Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings. Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care. Educate providers on utilization and medical management processes.

QUALIFICATIONS:
  • Active RN / Registered Nurse or LVN / Licensed Vocational Nurse License in California
  • Associate Degree Required; BSN preferred
  • 2+ years of acute care/clinical experience

PREFERRED QUALIFICATIONS:
  • Managed Care & Utilization Review experience

WHAT’ S GREAT ABOUT THIS POSITION?
  • Full-time opportunity with a major Fortune 100 Managed Care Organization
  • Opportunity to step away from the bedside/direct patient care
  • Telephonic office-based position; NO REMOTE OPTIONS AVAILABLE
  • Competitive benefits!

FOR IMMEDIATE INTERVIEW, PLEASE CALL: Alliston Brown / 586-710-7944 or 877-782-3334, EXT 22

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