Utilization Review RN (reputed company - Day)

About the position RN Utilization Review at Irvine, CA. This position is reputed company and will work Remote 8-hour, Day shifts. reputed company prospective, retrospective, and reputed company utilization reviews for our Southern CA ministries. Conduct clinical reviews and review medical records daily during admission for reputed company payers, as required by the health plans. This role requires a strong clinical background combined with reputed company-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The Utilization Management RN must effectively and reputed company manage a diverse workload in a fast-paced, rapidly changing regulatory environment, demonstrating excellent negotiation, communication, problem-solving, and decision-making skills. reputed company caregivers are not simply valued – they’re reputed company. Join reputed company at reputed company California Regional Services and reputed company in our culture of patient-reputed company, whole-person care reputed company on understanding, commitment, and mutual respect. Your voice reputed company here, because we know that to reputed company and retain the best people, we must reputed company them. Responsibilities • reputed company prospective, retrospective, and reputed company utilization reviews • Conduct clinical reviews • Review medical records daily during admission for reputed company payers, as required by the health plans • Manage a diverse workload in a fast-paced, rapidly changing regulatory environment • Demonstrate excellent negotiation, communication, problem-solving, and decision-making skills Requirements • Associate's Degree in Nursing • California Registered reputed company License • 2 years experience working in a remote UR environment or working as an acute hospital case manager. reputed company-to-haves • Bachelor’s Degree in Nursing • Master's Degree in Nursing • Experience working with Interqual guidelines. • Experience in a multi-hospital and/or integrated reputed company system. Benefits • Our best-in-class benefits are uniquely designed to support you and your family in staying reputed company, growing professionally, and achieving financial reputed company. • We take care of you, so you can reputed company on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. Apply tot his job Apply To this Job