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Prior Authorization Nurse Job

Eingestellt von Yoh

Gesuchte Skills: Client

Projektbeschreibung

PRIOR AUTHORIZATION NURSE needed for a CONTRACT opportunity with Yoh's client located in Santa Cruz, CA.

Top Skills Should You Possess:
- Previous case management or utilization management experience
- Knowledge of Medi-Cal

What You'll Be Doing:
- Ensure that prior authorization requests are completed in a timely fashion to meet contractual requirements and that all reviews are conducted using nationally recognized and evidence based standards
- Coordinate and follow the established preauthorization review process for outpatient and inpatient services
- Functioning as a resource for non-licensed staff in evaluating reviews for members with complex conditions
- Review both inpatient and outpatient authorization requests in an accurate, thorough and efficient manner

What You Need to Bring to the Table:
- Current California RN or LVN license
- A minimum of three (3) years of experience in a patient care setting
- A minimum of one (1) year of experience in utilization management, case management or an equivalent combination of education and experience
- Current working knowledge of Milliman Care Guidelines in review determination process
- Knowledge of Medi-Cal and related policy and Title 22 regulations
- Knowledge of utilization management principles and activities
- Knowledge of case management principles and activities
- Knowledge and understanding of concepts pertaining to prepaid health care

WHAT ARE YOU WAITING FOR? APPLY NOW!

RECRUITER: Jennifer Andersen

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.

J2W: HC

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Ref:

SFSF: HC

Projektdetails

  • Einsatzort:

    Santa Cruz, Vereinigte Staaten

  • Projektbeginn:

    asap

  • Projektdauer:

    Keine Angabe

  • Vertragsart:

    Contract

  • Berufserfahrung:

    Keine Angabe

Geforderte Qualifikationen

  • Kategorie:

    IT Entwicklung

  • Skills:

    client

Yoh