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in Salinas, CA

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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.


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Ref: 1055542

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