RN Utilization Management Nurse

Healthcare Support Staffing; Bakersfield (CA); On-site; USD 53,726; Full time

Benefits offered by this job

$2,000 sign-on bonus

Great benefits package

Job summary

A leading healthcare recruiting firm in California is seeking a professional for a role involving the review of medical services and coordination of care. The position offers pay up to $39/hr and includes a sign-on bonus and comprehensive benefits. Candidates should have a minimum of two years of clinical experience and preferably a Bachelor’s degree in Nursing or a related field. Responsibilities include processing referrals and communicating with healthcare providers to promote timely care coordination.

Qualifications

• Minimum two years full-time clinical experience in acute care or community health.
• Experience working with patients regarding self-care and disease management.
• Knowledge of community resources for seniors and disabled is a plus.

Responsibilities

• Reviews outpatient and elective medical services.
• Coordinates and refers members for carved-out services.
• Processes automatic referral requests with contract providers.

Skills

Clinical experience

Care coordination

Communication skills

Education

Bachelor’s Degree in Nursing or related healthcare field

Job description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Salary: Pays up to $39/hr ($2,000 sign on bonus) with great benefits package

Shift: Monday to Friday 8:00AM to 5:00PM

• Performs review of requested outpatient and elective, prospective inpatient medical services.
• Under the direction of the UM Clinical Supervisor coordinates and refers KHS members for services which are carved out of KHS medical coverage.
• Assists in the authorization and processing of automatic referral requests.
• Responsible for written and verbal communication with contract providers and internal KHS staff to promote timely coordination of care and dissemination of KHS policies and procedures.
• Collaborates with the KHS Member Service Department and the Provider Relations Department regarding quality of care and other grievance issues in order to facilitate timely problem resolutions.
• Utilizes Milliman and Medicaid criteria to review DME, home care, rehab and SNF referrals for medical necessity and benefit coverage while processing referral request.
• Identifies and refers quality of care, coordination of benefits, and third party liability issues as appropriate.
• Maintains knowledge of covered benefits for all programs.
• Shares information as necessary with appropriate Case Manager, Disease Management Nurse, or Social Worker.
• Identifies and refers cases appropriate for Case Management evaluation.
• Identifies authorization issues and brings those requiring attention to the UM Supervisor.

Qualifications

• Minimum of two years (2) full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management required.
• Experience working with patients and caregivers regarding self-care and disease management required.
• Experience working in case management or care coordination is a plus.
• Knowledge of Kern County Community resources for seniors and people with disabilities is a plus.
• Bachelor’s Degree from an accredited school or equivalent in Nursing, Health Administration or related healthcare field preferred.

Additional Information

Interested in being considered?

If you are interested in applying to this position, please contact Edgar Pablo @ 407-478-0332 ext 114 and click the Green I’m Interested Button to email your resume.