Senior Clinical Quality Nurse Reviewer – Utilization Mgmt

L.A. Care; Idaho; Presencial; USD 89 000 - 142 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Resumo da oferta

L.A. Care Health Plan is seeking an Utilization Management Clinical Quality Nurse Reviewer RN II in Idaho. The role audits UM documentation, ensures regulatory compliance, and supports policy development within the Utilization Management team.

The position requires extensive nursing experience, strong analytical skills, and ability to lead improvement initiatives across regulatory audits and performance metrics.

Qualificações

• At least 5 years of experience in clinical nursing.
• Minimum of 2 years auditing clinical documentation.
• Active participation in multiple state and federal audits.
• Experience with Medi-Cal and Medicare in managed care.

Responsabilidades

• Conduct and track targeted internal documentation audits.
• Ensure UM practices meet regulatory requirements.
• Lead audit preparation and follow-up activities.
• Develop and review policies to certify compliance.
• Generate quality reports and present findings to QA and UM leadership.
• Identify opportunities for quality improvements.

Conhecimentos

Analytical skills

Regulatory compliance

Auditing

Communication skills

Team building

Self-directed

Multitasking

Documentation skills

Formação académica

Associate's Degree in Nursing

Bachelor's Degree (preferred)

Master's Degree in Nursing (preferred)

Ferramentas

Microsoft Excel

Microsoft Word

Descrição da oferta de emprego

L.A. Care Health Plan is seeking an Utilization Management Clinical Quality Nurse Reviewer RN II in Idaho. The role audits UM documentation, ensures regulatory compliance, and supports policy development within the Utilization Management team.

The position requires extensive nursing experience, strong analytical skills, and ability to lead improvement initiatives across regulatory audits and performance metrics.