Concurrent Review Nurse Job

CONCURRENT REVIEW NURSE needed for a CONTRACT opportunity with Yoh's client located in Merced, CA.

THE BIG PICTURE - TOP SKILLS YOU SHOULD POSSESS:

- Utilization Review Experience
- Case Management Experience
- Registered Nurse

WHAT YOU'LL BE DOING:

- Responsible for concurrent and/or post service review of acute in-patient care services
- Participate in the utilization management transitions of care program to achieve goals of improved member outcomes
- Coordinate and facilitates a preauthorization review system for outpatient services to expedite hospital discharges
- Maintain documentation of clinical reviews in utilization management software system according to policy
- Review medical records to determine benefit coverage including appropriateness and level of care
- Other duties as assigned

WHAT YOU NEED TO BRING TO THE TABLE:

- One (1+) years of experience in utilization management, case management or equivalent
- Registered Nursing license in California
- Three (3+) years of experience an acute care setting preferred
- Working knowledge of Title 22 regulations and Medi-Cal and related policies
- Working knowledge of Milliman Guidelines
- Advanced use of MS Office and Word

OPPORTUNITY IS CALLING, APPLY NOW!

RECRUITER: Emi Flaherty

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Click here to contact us if you are an individual with a disability and require accommodation in the application process.