California Licensed Utilization Review Nurse

Company: VirtualVocations
Location: Newark
Posted on: February 1, 2025

Job Description:

A company is looking for a Utilization Review Nurse to ensure high-quality care for health plan members.

Key Responsibilities

Conduct utilization management activities in line with health plan policies and regulations
Identify and report Potential Quality Issues and support Provider Dispute Resolution processes
Complete additional duties as assigned

Required Qualifications

BSN or MSN degree
Current valid California RN license
Two or more years of experience in utilization management, preferably in Medicare Advantage or managed care
Knowledge of Medicare Advantage regulatory guidelines and CMS regulations
Experience with Potential Quality Issues identification and reporting

Keywords: VirtualVocations, East Orange , California Licensed Utilization Review Nurse, Healthcare , Newark, New Jersey

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