California Licensed Utilization Management Nurse

VirtualVocationsToms River, New Jersey, United States

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A company is looking for a UM Nurse, RN for the Weekend Shift.

Key Responsibilities

Conduct prospective and concurrent / retrospective reviews of referrals to ensure compliance with regulatory requirements

Utilize nationally recognized UM criteria to meet Member needs effectively

Support the Quality Program goals including HEDIS, CAHPS, and NCQA Accreditation

Required Qualifications

Two or more years of utilization management experience in a healthcare delivery setting or an acute care facility

Experience in an HMO or Managed Care setting is preferred

High school diploma or GED required; Bachelor's degree in Nursing preferred

Possession of an active, unrestricted Registered Nurse (RN) license issued by the California BRN

Valid California Driver's license is required

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Utilization Management Nurse • Toms River, New Jersey, United States

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