RN Utilization Review - Full-time Day- REMOTE

Overview RN Utilization Review at Irvine, CA. This position is Full-time and will work Remote 8-hour, Day shifts.
Provide prospective, retrospective, and concurrent utilization reviews for our Southern CA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, as required by the health plans. This role requires a strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The Utilization Management RN must effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment, demonstrating excellent negotiation, communication, problem-solving, and decision-making skills.
Qualifications Associate's Degree Nursing.
Upon hire: California Registered Nurse License
2 years experience working in a remote UR environment or working as an acute hospital case manager.
Preferred Qualifications Bachelor's Degree Nursing.
Master's Degree Nursing.
Experience working with Interqual guidelines.
Experience in a multi-hospital and/or integrated healthcare system.
Equal Employment Opportunity Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
Other details Requisition ID: 424992
Job Category: Health Information Management
Job Function: Revenue Cycle
Job Schedule: Multiple shifts available
Career Track: Nursing
Department: 7000 UTILIZATION MGMT OCHD
Address: CA Irvine 15480 Laguna Canyon Rd
Work Location: Providence System Offices Discovery Park-Irvine
Workplace Type: Remote
Pay Range: $56.44 - $87.63

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