Utilization Review RN - Utilization Management
Providence · Los Angeles, CA · 3 mo ago
On-siteHealthcare$57.28–$88.92/hrFull-time
About the role
Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members.
Responsibilities
- Provide utilization review and coordination of care throughout the healthcare continuum.
- Collaborate with interdisciplinary teams to ensure quality and cost-effective care.
- Apply Milliman criteria in decision-making processes.
- Support clinical staff in developing and implementing care plans.
- Monitor and evaluate care delivery to identify areas for improvement.
- Ensure compliance with regulatory standards and guidelines.
Requirements
- Nursing school graduate.
- California Registered Nurse License.
- 3 years' experience in utilization management and/or case management.
- 3 years clinical experience in hospital or medical office/clinic setting.
- Experience with Milliman criteria.
Preferred Qualifications
- Bachelor's Degree in Nursing or related field.
- Certification in Case Management (CCM).
Benefits
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more.