Utilization Management Specialist Job

REGISTERED NURSE UTILIZATION MANAGEMENT NURSE SPECIALIST needed for a CONTRACT opportunity with Yoh's client located in Los Angeles, CA.

TOP SKILLS SHOULD YOU POSSESS:

- Registered Nurse Licensure in State of CA (Active and in Good Standing)
- Utilization Management Experience in a Managed Care and HMO Setting
- Prospective, concurrent and Retrospective Referral Experience

WHAT YOU'LL BE DOING:

- Works closely with the Utilization Manager and Physician Advisor on case reviews for retrospective, concurrent claims medical review
- Acts as a department resource for medical services request/referral
- management and processes.

WHAT YOU NEED TO BRING TO THE TABLE:

- Registered Nurse Licensure in State of CA(Active and in Good Standing)
- Three to five (3-5) years of Utilization Management Experience in an HMO/Managed Care Setting
- Must have Prior Authorization, Prospective, Concurrent and Retrospective Referral Experience
- Experienced in utilizing Milliman Criteria Guidelines
- Experienced in writing denial Letters

OPPORTUNITY IS CALLING, APPLY NOW!

RECRUITER: Christine Mosessian

PHONE NUMBER:587-4463

Yoh, a DayTHIS ADDRESS IS EXCLUSIVELY FOR INDIVIDUALS WITH DISABILITIES REQUESTING APPLICATION ASSISTANCE.