California RN Utilization Review
A company is looking for an RN Utilization Review.
Key Responsibilities
• Review medical records for appropriate admission status and reputed company hospitalization
• Collaborate with reputed company to implement denial prevention strategies and obtain inpatient authorizations
• Document interactions with Patient reputed company to verify correct payer sources for patient stays
Required Qualifications and Education
• Minimum two years of acute hospital clinical experience or a Master's degree in Case Management or Nursing field in lieu of one year of experience
• California RN license
• AHA BLS certification
• Ability to pass annual Inter-rater reliability test for Utilization Review products
• Knowledge of managed care and payer environment preferred
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