Registered Nurse Utilization Review Case Manager

San Diego, CA 92121

Employment Type: Direct Job Category: Registered Nurse RN Job Number: 46235

We are searching for a UM Review/CM Registered Nurse to join the RN Case Management team for an established managed care organization. This is a full time, permanent role and an office-based position. The hours are Monday-Thursday 6:30AM to 5:00PM (4 day work week!!!!). This position offers a competitive salary, comprehensive benefits package, generous PTO, and 401K company match.

As a Case Management Nurse you will:

  • Ensure proper utilization of services by assessing the needs and identifying solutions that promote quality and cost-effective care.
  • Conduct Quality Assurance reviews as necessary.
  • Determine medical appropriateness of services by evaluating medical guidelines, benefit determination and compliance with state mandated regulations based on Milliman and/or InterQual criteria.
  • Identify solutions to problems and non-standard requests
  • Maintain compliance with regulatory agency requirements
  • Collaborate with staff, physicians, and other members of the interdisciplinary team to coordinate and provide the level of care necessary to meet health needs

Requirements:

  • Current California Registered Nurse license
  • Knowledge of managed care organization/IPA/health plan Registered Nurse case management preferred
  • 2+ years of Registered Nurse clinical nursing experience in a clinical, acute care, or community setting
  • CCM Preferred
  • Utilization Management UM and/or Utilization Review UR Experience Preferred

Why Work Here:

  • Competitive starting pay
  • Comprehensive benefits package including PTO, Sick Pay, Holiday Pay, 401K w/match, Med/Den/Vis/Life Insurance, Short/Long Term leave, etc.
  • Very large and growing organization with several opportunities for advancement
  • Consistent, standard 40 hour work week only 4-day work week! Mon Thurs, 6:30 am to 5:00 pm
  • Opportunity to work among interdisciplinary team as well as independently in a fast-paced, educational environment
  • Ability to manage care for variety of those in need

This is a direct-hire, permanent, full-time position with a 4-day work week, Mon - Thurs, working 4 10 hour shifts, an established and growing healthcare organization. Please submit your resume to Kasey at kklumpp@medicalprofessionals.com to learn more about our client!

Apply Online
Apply with LinkedIn Apply with Facebook

Send an email reminder to:

Share This Job:

Related Jobs:

Login to save this search and get notified of similar positions.