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Utilization management & quality review nurse
Location:
Los Angeles, CA
Description:
General InformationPress space or enter keys to toggle section visibilityWork Location: Los Angeles, USAOnsite or RemoteFlexible HybridWork ScheduleMonday-Friday, 8:00am-5:00pm PSTPosted Date10/30/2024Salary Range: $61.79 - 79.91 HourlyEmployment Type2 - Staff: CareerDurationIndefiniteJob #20146Primary Duties and ResponsibilitiesPress space or enter keys to toggle section visibilityAs the Utilization Management & Quality Review Nurse, you will be responsible for:* Ensuring appropriate, cost-effective, and high-quality care for New Century Health Plan members* Conducting utilization management (UM) activities in accordance with health plan policies and regulatory guidelines* Identifying and reporting Potential Quality Issues (PQI) and supporting Provider Dispute Resolution (PDR) processes to ensure compliance and foster provider satisfaction* Completing other duties as assignedSalary Range: $61.79 - $79.91/hourlyJob QualificationsPress space or enter keys to toggle section visibilityWe're seeking a highly qualified candidate with:* A BSN or MSN degree, required* Current valid California RN license, required* Two or more years of experience in utilization management, preferably in Medicare Advantage or managed care* Knowledge of Medicare Advantage regulatory guidelines, including CMS regulations* Experience with Potential Quality Issues (PQI) identification and reporting* Familiarity with Provider Dispute Resolution (PDR) processes* Strong clinical assessment and critical thinking skills* Proficiency in electronic health records (EHR) and utilization management software* Excellent written and verbal communication skillsFor more details: https://jobs-search.org/utilization-management_los-angeles-c426443/utilization-management-quality-review-nurse_i2459388569
Posted:
November 17 on Jobs-Search
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More About this Listing: Utilization management & quality review nurse
Utilization management & quality review nurse is a Nurse & Healthcare Nurse Job located in Los Angeles CA. Find other listings like Utilization management & quality review nurse by searching Oodle for Nurse & Healthcare Nurse Jobs.
Utilization management & quality review nurse is a Nurse & Healthcare Nurse Job located in Los Angeles CA. Find other listings like Utilization management & quality review nurse by searching Oodle for Nurse & Healthcare Nurse Jobs.