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Utilization Management - 29233-1
3300 Zinfandel Drive Rancho Cordova, California 95670 | Contract
RN UTLIZATION CASE MANAGER
Working with complex cases promotes the delivery of quality; cost- effective health care services based on medical necessity and contractual benefits. Works with other members of HCS team, provider, hospitals, members and their families to plan and review medical necessity, intensity of services, level of care, length of stay and general appropriateness of care.
- Manage cases for UM
- Review for medical necessity for members requesting medical treatment
- Communicate to providers, colleagues and MD' s utilizing phone and PC systems
- Support to senior/ lead CMs as needed
- 3 years of acute care experience
- Current active unrestricted CA RN license
- Bachelors of Science in Nursing or advanced degree
- Software Skills: Word and Excel
Job Type: Contract Full-Time
Salary: $40.00 - $45.00/ hour