An employer is looking for an Utilization Management Nurse to work for a large Healthcare company in Orange County, CA. This position is 100% telephonic and a remote position (training will be completely remote). An Utilization Management Nurse will be responsible for reviewing authorization requests in which doctor's order. They will be reviewing these authorizations to make sure that guidelines are met per the doctor's order based on evidence based and supported with the guidelines. An Utilization Management nurse can't deny care or make any final decisions. This is only approved/supported by a Medical Director or Pharmacist. This is a remote position but most be 50 miles from Southern California.
2+ years Utilization Management/Managed Care Experience
LVN Active License
Excellent computer skills
High School Degree
Experience with health plan eligibility and health care benefits, experience with referrals, authorizations, setting up transportation, etc
Medical Terminology Understanding
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.