RN Utilization Review & Quality Assurance Specialist

Emanate Health; Covina (CA); On-site; USD 50,000 - 85,000; Full time

Job summary

Join a leading health care system recognized for excellence, where your role as a Utilization Review Nurse will be pivotal in evaluating medical records and ensuring the delivery of quality care. In this position, you will apply your clinical acumen to assess medical necessity and support medical claims, all while being part of a dedicated team that values community impact and individual growth. With a strong emphasis on collaboration and excellence, this is an opportunity to contribute to a top-ranked health care organization while enhancing your professional skills in a supportive environment.

Qualifications

• Minimum of three years of utilization management experience.
• California RN license is required.

Responsibilities

• Evaluate medical records to determine medical necessity.
• Document decisions using clinical guidelines and protocols.

Skills

Utilization Management

Clinical Judgment

Customer Service Skills

Computer Proficiency

Education

California RN License

Job description

Join a leading health care system recognized for excellence, where your role as a Utilization Review Nurse will be pivotal in evaluating medical records and ensuring the delivery of quality care. In this position, you will apply your clinical acumen to assess medical necessity and support medical claims, all while being part of a dedicated team that values community impact and individual growth. With a strong emphasis on collaboration and excellence, this is an opportunity to contribute to a top-ranked health care organization while enhancing your professional skills in a supportive environment.