What are the responsibilities and job description for the Utilization Management Nurse, Senior position at Blue Shield of CA?
Your Role
The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information provided by the facilities to determine medical necessity when our members admit. You will also be involved with discharge planning and transfers as needed for higher levels of care or out of network admissions.
Your Knowledge and Experience
- Bachelors of Science in Nursing or advanced degree preferred.
- Requires a current California RN License
- Requires at least 5 years of prior relevant experience
- Requires strong communication and computer navigation skills
- Desires strong teamwork and collaboration skills
- Requires independent motivation and strong work ethic
- Requires strong critical thinking skills
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
