Utilization Management Nurse

We are looking to hire one stellar candidate who has an unrestrictive RN license and a passion for learning to join one of our large client accounts in Rancho Cordova, CA. You will be performing prospective reviews and first level determination approvals for members using FEP and BSC evidenced based guidelines, policies, and nationally recognizedf clinical criteria across FEP's line of business. Ensures diagnosis matches ICD-10 codes. This is a contract opportunity and our client is looking for someone driven, dedicated, and determined to succeed in this fast-paced environment.

Hours: Monday - Friday; 8:00AM - 5:00PM

Pay Rate: $45.25 / hour


UTILIZATION MANAGEMENT NURSE ESSENTIAL JOB FUNCTIONS (include the following):

1. Effectively manage utilization trends to ensure that members receive clinical services at the most appropriate & cost-effective level of care
2. Effectively communicates with members & providers on their PSR authorization requests
3. Triages & prioritizes cases to meet required, regulatory turn-around times. Expedites access to appropriate care for members with urgent needs using expedited review process.
4. Identifies potential quality of care issues, service, or treatment delays & intervenes or as clinically appropriate


Current active unrestricted CA RN License is required. Please apply for immediate consideration.


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Reference number US_EN_2_108175_332629