IEHP
2 days ago Be among the first 25 applicants
Overview Under the general direction of the Utilization Management Manager, the Utilization Management Nurse is responsible for prospective and concurrent/retrospective review of referrals ensuring regulatory requirements are being met as they relate to language readability and appropriate citation of criteria in Member correspondence. This position is responsible to ensure meeting Member’s needs using nationally recognized UM criteria.
What you can expect Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience.
Commitment to Quality The IEHP Team is committed to incorporating IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Perks
Competitive salary
Telecommute schedule
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance
Education & Requirements
Two (2) or more years of utilization management experience in a health care delivery setting specifically in prior authorization or two (2) or more years of experience in an acute care facility
Experience in an HMO or experience in a Managed Care setting preferred
High school diploma or GED required
Bachelor's degree in Nursing from an accredited institution preferred
Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
Key Qualifications
Must have a valid California Driver’s license
Knowledge of Title 22, Title 10, DMHC, DHCS, and CMS regulatory requirements specifically as they relate to UM/Health Plan correspondence.
Exhibits a high attention to detail in documenting UM referral reviews
Ability to work at a high level of speed while maintaining accuracy
Ability to work well with both physician and nursing staff
Pay Range
$91,249.60 USD Annually - $120,910.40 USD Annually
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
Referrals increase your chances of interviewing at IEHP by 2x
Get notified about new Registered Nurse jobs in
Rancho Cucamonga, CA .
#J-18808-Ljbffr
Overview Under the general direction of the Utilization Management Manager, the Utilization Management Nurse is responsible for prospective and concurrent/retrospective review of referrals ensuring regulatory requirements are being met as they relate to language readability and appropriate citation of criteria in Member correspondence. This position is responsible to ensure meeting Member’s needs using nationally recognized UM criteria.
What you can expect Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience.
Commitment to Quality The IEHP Team is committed to incorporating IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Perks
Competitive salary
Telecommute schedule
State of the art fitness center on-site
Medical Insurance with Dental and Vision
Life, short-term, and long-term disability options
Career advancement opportunities and professional development
Wellness programs that promote a healthy work-life balance
Flexible Spending Account – Health Care/Childcare
CalPERS retirement
457(b) option with a contribution match
Paid life insurance for employees
Pet care insurance
Education & Requirements
Two (2) or more years of utilization management experience in a health care delivery setting specifically in prior authorization or two (2) or more years of experience in an acute care facility
Experience in an HMO or experience in a Managed Care setting preferred
High school diploma or GED required
Bachelor's degree in Nursing from an accredited institution preferred
Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
Key Qualifications
Must have a valid California Driver’s license
Knowledge of Title 22, Title 10, DMHC, DHCS, and CMS regulatory requirements specifically as they relate to UM/Health Plan correspondence.
Exhibits a high attention to detail in documenting UM referral reviews
Ability to work at a high level of speed while maintaining accuracy
Ability to work well with both physician and nursing staff
Pay Range
$91,249.60 USD Annually - $120,910.40 USD Annually
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Hospitals and Health Care
Referrals increase your chances of interviewing at IEHP by 2x
Get notified about new Registered Nurse jobs in
Rancho Cucamonga, CA .
#J-18808-Ljbffr