Utilization Review RN
Responsibilities
- Works on behalf of the advocate, promoting cost containment.
- Demonstrates leadership to integrate healthcare providers to achieve seamless delivery of care.
- Facilitates and ensures quality, clinical, and cost-effective outcomes through a holistic and comprehensive review of the medical record.
Qualifications
- Minimum 7 years post-graduate of an accredited school of nursing and current state Registered Nurse license.
- Minimum 3 years RN Utilization Manager experience for a Health Plan.
- At least 3 years of experience in utilization review, referrals, authorizations, denials, and appeals.
- Current BCLS (AHA) certificate upon hire and maintain current.
- Knowledge of MCG Criteria and/or InterQual Criteria required.
- Experience and knowledge in basic to intermediate computer skills.
Preferred Qualifications
- Five years acute care nursing experience preferred.
- Experience with self-funded health plan preferred.
Pay
A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $71,760.00 to $104,000.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Benefits
- Paid time off
- 401K retirement plan
- Medical, dental, and vision coverage
- Tuition reimbursement
- Many voluntary benefit options
Employment Status
Full Time
Shift
Days
Equal Employment Opportunity
The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Privacy Notice
Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf