Utilization Review Nurse (RN/LVN) - Mon-Fri, Onsite

Universal Healthcare IPA, Inc.; Bakersfield (CA); On-site; USD 42,705 - 74,638; Full time

Benefits offered by this job

Medical

Dental

Vision

Simple IRA Plan with Employer Contribution

Employer Paid Life Insurance

Employee Assistance Program

Job summary

Universal Healthcare IPA, Inc. is looking for a UM Nurse Reviewer to conduct utilization reviews and ensure members receive necessary care. The ideal candidate will have an active California RN or LVN license and experience in managed care.

The role involves collaboration with teams to meet regulatory guidelines and provide high-quality service. Benefits include medical, dental, vision, and more, alongside a competitive compensation package based on experience.

Qualifications

• Active unrestricted California RN or LVN license required.
• At least one year of managed care experience is preferred.
• Proficient in PC Software skills.

Responsibilities

• Conduct timely reviews of pre-certification and concurrent requests.
• Ensure that members receive suitable care while adhering to guidelines.
• Collaborate with stakeholders to address member needs.

Skills

Active Unrestricted Current California RN or LVN license

Managed care experience

Communication skills

Problem solving

ICD-10, CPT coding knowledge

PC Software skills

Job description

Universal Healthcare IPA, Inc. is looking for a UM Nurse Reviewer to conduct utilization reviews and ensure members receive necessary care. The ideal candidate will have an active California RN or LVN license and experience in managed care.

The role involves collaboration with teams to meet regulatory guidelines and provide high-quality service. Benefits include medical, dental, vision, and more, alongside a competitive compensation package based on experience.