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in Salinas, CA
Concurrent Review Nurse Job - Full-time / Part-time
•30 days ago
Hours | Full-time, Part-time |
---|---|
Location | Salinas, CA Salinas, California |
About this job
Concurrent Review Nurse needed for a permanent opportunity with Yoh's client located in Salinas, CA
Top Skills Should You Possess:
- Previous case management experience
- Knowledge of Medi-Cal & Milliman
What You'll Be Doing:
- Perform concurrent or post-service review of acute in-patient care services, as required, by the use of established criteria
- Perform preauthorization, concurrent and post-service review for all acute, sub-acute , skilled nursing facilities utilizing the established criteria/protocols
- Maintain documentation of clinical reviews in Utilization Management software system
- Interpret benefits based on the benefit language as outlined in Title 22, Provider Manual, and plan policies and procedures, to evaluate appropriate care for all lines of business
- Review medical records to determine benefit coverage including appropriateness and level of care
- Assist Member Services, Claims and Provider Services departments with issues that require medical interpretation or definition
What You Need to Bring to the Table:
- Current California RN license
- Minimum 3 years of experience in an acute care setting
- Minimum 1 year of experience in utilization management or case management
- Working knowledge of Milliman Care Guidelines in review determination process desirable;
- Knowledge of utilization management principles and activities
- Knowledge of case management principles and activities
- Knowledge of Medi-Cal and related policy and Title 22 regulations
- Understanding of concepts pertaining to prepaid health care
What are you waiting for? Apply Now!
Recruiter: Annie Gill
Yoh makes finding and applying for jobs simple. Partner with Yoh to find the right opportunities across multiple industries in the US and UK. Find out more !
Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. to contact us if you are an individual with a disability and require accommodation in the application process.
J2W: HC
MONJOB
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Ref: 1055542
SFSF: REN