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Utilization Management RN
Job ID:00004D59
Catergory:MedicalDental
Location:CA Camarillo
Hours:40 Monday to Friday 800am to 500pm
Pay:$31.00 $37.00
Utilization Management RN needed in Camarillo
Job Description
Will review requests for medical services against National Clinical Guidelines, uses judgment in selecting appropriate guidelines and in applying general policies and procedures. Responsible for assuring the receipt of high quality, cost-efficient medical outcomes for those enrollees identified as having the need for inpatient andor outpatient precertificationpreauthorization. Responsible for screening enrollees for initiatives and programs including Case Management and Disease Management. Review precertification requests for medical necessity, referring to the Medical -Director those that require additional expertise. Establish effective rapport with other employees, professional support service staff, customers, clients, patients, families, and physicians. Interfaces with internal resources including Medical Directors and other Health Services staff to ensure members receive the right care at the right time in the right setting by the right provider.
Skills Required
BA Degree in Nursing, Healthcare or Case Management. Registered RN. Case management andor utilization review experience. Knowledge of basic computer applications with ability to adapt to new software programs.
Skills Preferred