What are the responsibilities and job description for the RN, Utilization Management, Full Time, Days – Alternating Weekends position at Working Nurse?
RN Job
RN, Utilization Management, Full Time, Days – Alternating Weekends
Shift
Full Time, Days - Alternating Weekends
Pay Range
$53.08-79.85
Job ID
26555
Location
Los Angeles, 90017
Apply at Website
Email Recruiter
Job Description
The Utilization Management (UM) RN performs utilization review activities, including, but not limited to, precertification, ensures appropriate level of care and status (Inpatient, Outpatient, and Observation) throughout admission and performs concurrent reviews/retrospective reviews according to guidelines.
Determines the medical necessity of requests by performing first level reviews. The UM nurse ensures a process that is efficient for providing care, ensuring timely and appropriate levels of care for the incoming patients. UM RN is responsible for preparing cases for Physician Advisor for 2nd level review.
Qualifications
Required:
Come to Good Samaritan for a richness of experience beyond the practice of exceptional medicine. With a multi-cultural staff of more than 1,600 employees and 650 physicians, we offer opportunities to work and grow among people from a wide variety of cultures, backgrounds and traditions.
RN, Utilization Management, Full Time, Days – Alternating Weekends
Shift
Full Time, Days - Alternating Weekends
Pay Range
$53.08-79.85
Job ID
26555
Location
Los Angeles, 90017
Apply at Website
Email Recruiter
Job Description
The Utilization Management (UM) RN performs utilization review activities, including, but not limited to, precertification, ensures appropriate level of care and status (Inpatient, Outpatient, and Observation) throughout admission and performs concurrent reviews/retrospective reviews according to guidelines.
Determines the medical necessity of requests by performing first level reviews. The UM nurse ensures a process that is efficient for providing care, ensuring timely and appropriate levels of care for the incoming patients. UM RN is responsible for preparing cases for Physician Advisor for 2nd level review.
Qualifications
Required:
- Maintain an active California RN license.
- LA City Fire Card within 6 months of employment
- BLS from American Heart Association
- Minimum of 2 years’ acute hospital experience.
- Knowledge of payer requirements.
- Certified Case Manager or Accredited Case Manager
- BSN preferred.
- Experience with Milliman Care Guidelines (MCG)
Come to Good Samaritan for a richness of experience beyond the practice of exceptional medicine. With a multi-cultural staff of more than 1,600 employees and 650 physicians, we offer opportunities to work and grow among people from a wide variety of cultures, backgrounds and traditions.
Salary : $53 - $80