Telecommute Utilization Management Nurse, RN

IEHP; United States; Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

CalPERS retirement and 457(b) option

Telecommute schedule

Job summary

IEHP is seeking an RN with clinical patient care experience in an acute care setting to conduct medical necessity reviews and collaborate with the UM Medical Director on determinations. The role involves drafting denial language to apply standardized, nationally recognized UM criteria.

The candidate should possess an active California BRN RN license, a high school diploma or GED (Bachelor's in nursing preferred), and be eligible for telecommute arrangements.

Qualifications

• Minimum two years of clinical patient care experience in an acute care facility with an active RN license.
• High school diploma or GED required; Bachelor's degree in nursing preferred.
• Possession of an active, unrestricted Registered Nurse license issued by the California BRN required.
• Competitive salary and telecommute schedule.
• Medical, dental, and vision insurance with life and disability options.
• CalPERS retirement and 457(b) option with contribution match.

Responsibilities

• Conduct prospective, concurrent, and retrospective reviews for medical necessity and appropriateness of services.
• Collaborate with UM Medical Director on reviews and final determination.
• Draft denial language to ensure consistent application of standardized, nationally recognized UM criteria.

Skills

RN license

Clinical patient care

Education

Bachelor's degree in nursing

Job description

IEHP is seeking an RN with clinical patient care experience in an acute care setting to conduct medical necessity reviews and collaborate with the UM Medical Director on determinations. The role involves drafting denial language to apply standardized, nationally recognized UM criteria.

The candidate should possess an active California BRN RN license, a high school diploma or GED (Bachelor's in nursing preferred), and be eligible for telecommute arrangements.