Senior Utilization Management Nurse (Hybrid) Review

Blue Shield of CA; San Diego (CA); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Blue Shield of CA seeks a Utilization Management Concurrent Review Nurse to evaluate inpatient stays under evidence-based guidelines, determining authorizations for Medicare, Medical, and Commercial plans. You will apply medical necessity and clinical judgment within policy.

This hybrid role requires an active CA RN license, 5+ years of experience, and strong communication, teamwork, independence, and critical thinking skills; occasional in-office days may be required.

Qualifications

• Must maintain an active, unrestricted CA RN license.
• Associate's degree in nursing is required.
• Bachelor of Science in Nursing is preferred.
• Requires at least 5 years of prior relevant experience.
• Requires strong communication and computer navigation skills.
• Desires strong teamwork and collaboration skills.
• Requires independent motivation and strong work ethic.
• Requires strong critical thinking skills.

Skills

Communication

Computer navigation

Teamwork

Independent motivation

Critical thinking

Education

Associate's degree in nursing

Bachelor of Science in Nursing

Job description

Blue Shield of CA seeks a Utilization Management Concurrent Review Nurse to evaluate inpatient stays under evidence-based guidelines, determining authorizations for Medicare, Medical, and Commercial plans. You will apply medical necessity and clinical judgment within policy.

This hybrid role requires an active CA RN license, 5+ years of experience, and strong communication, teamwork, independence, and critical thinking skills; occasional in-office days may be required.