Registered Nurse Utilization Review Case Manager
San Diego, CA 92121
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
- 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 firstname.lastname@example.org to learn more about our client!