Position Overview
This role offers the opportunity to work 100% remotely, provided you reside in California and hold an active RN license. The schedule is Monday to Friday, from 8:00 AM to 5:00 PM PST.
Compensation And Benefits
- Hourly pay ranges from \(40 to \)42, depending on experience.
- Full-time employees are eligible for benefits after 90 days, including a 401(k) with company match after one year of service.
Qualifications
- Active Registered Nurse (RN) license in California.
- Residency in California is required.
- 2-4 years of experience in hospital settings, managed care, or utilization management.
- Familiarity with healthcare systems and managed care practices is preferred.
- Understanding of Medicare and Medicaid Utilization Review processes.
- Strong computer skills, with proficiency in Microsoft systems; experience with TruCare is a plus.
Responsibilities
- Conduct concurrent and continued stay reviews to ensure appropriate care and setting, adhering to established guidelines and policies.
- Approve services or escalate requests to the Physician or Medical Director for further evaluation.
- Perform medical necessity and level of care reviews for requested services using InterQual guidelines, referring to Medical Directors as needed based on case findings.
- Collaborate with staff within provider networks and the discharge planning team, both electronically and via phone, to coordinate comprehensive member care.
- Assist in discharge planning efforts and educate providers on utilization and medical management processes.
- Serve as a clinical resource for non-clinical team members, sharing your expertise and knowledge.
- Enter and maintain relevant clinical information in various medical management systems.
We look forward to welcoming a dedicated and knowledgeable nurse to our team who is passionate about improving patient care!
Employment Type: Full-Time