Senior Utilization Management Nurse - Hybrid & Impactful

Blue Shield of CA; Rancho Cordova (CA); Híbrido; USD 95.000 - 140.000; Jornada completa

Descripción de la vacante

Blue Shield of California is seeking an Utilization Management Concurrent Review Nurse to review inpatient stays and apply evidence-based guidelines across Medicare, Medical, or Commercial plans. You will determine authorization requests based on medical necessity and clinical judgment, reporting to the Utilization Management Nurse Manager.

The role requires an active, unrestricted CA RN license, an associate degree (BSN preferred), and at least five years of relevant experience.

Formación

• CA RN license active and unrestricted
• Associate's degree in nursing required
• BSN preferred
• At least 5 years of relevant experience
• Strong communication and computer navigation skills
• Strong teamwork and collaboration skills
• Independent motivation and strong work ethic
• Strong critical thinking skills

Responsabilidades

• Perform first level determination for authorization requests using guidelines, policies, and criteria across Medicare, Medical, or Commercial plans
• Review inpatient stays and determine appropriate level of care and medical necessity
• Apply evidence-based guidelines and policies to review decisions
• Make clinical judgments to complete review decisions based on benefit plans

Conocimientos

Communication

Teamwork

Independent motivation

Critical thinking

Work ethic

Computer navigation

Educación

Associate's degree in nursing

Bachelor of Science in Nursing

Descripción del empleo

Blue Shield of California is seeking an Utilization Management Concurrent Review Nurse to review inpatient stays and apply evidence-based guidelines across Medicare, Medical, or Commercial plans. You will determine authorization requests based on medical necessity and clinical judgment, reporting to the Utilization Management Nurse Manager.

The role requires an active, unrestricted CA RN license, an associate degree (BSN preferred), and at least five years of relevant experience.