California Licensed Preservice Review Nurse

Job Summary

A company is looking for a RN, Preservice Review Nurse - Remote.

Key Responsibilities

• Perform pre-service clinical coverage review of inpatient and outpatient services
• Gather clinical information to assess and expedite care needs
• Communicate with appropriate team members to troubleshoot complex cases

Required Qualifications

• Graduation from an accredited school of Nursing
• Current California RN license
• Undergraduate degree (BSN) or equivalent experience (preferred)
• Utilization management and prior authorization experience (preferred)
• Working knowledge of CMS health plan and MCG criteria (preferred)