California Licensed Utilization Management RN

Job Summary

A company is looking for an Outpatient Utilization Management RN.

Key Responsibilities:

• Reviews authorization requests for medical necessity and documents the process in the authorization system
• Processes medical necessity denials and refers them to the physician for review, ensuring compliance with established timeframes
• Obtains additional information for appeals and coordinates with health plans to meet expedited appeal timeframes

Required Qualifications:

• Registered Nurse with an active California License
• Proficient with computers in a Microsoft Windows environment
• 5+ years of RN experience preferred
• Experience in utilization management in a managed care environment is preferred