RN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr

Current Emanate Health Employees - Please log into your Workday account to apply

Everyone at Emanate Health plays a vital role in the care we deliver. No matter what department you belong to, the work you do at Emanate Health affects lives. When you join Emanate Health, you become part of a team that works together to strengthen our communities and grow as individuals.

On Glassdoor's list of "Best Places to Work" in 2021, Emanate Health was named the #1 ranked health care system in the United States, and the #19 ranked company in the country.

JobSummary

The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and the appropriate application of policies and guidelines to urgent and standard reviews. You will document decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings.

JobRequirements

MinimumEducationRequirement :

Minimum Experience Requirement :

Minimumof three yearsof utilization managementexperience. Experience inquality- related job preferred. Computer proficiency is required.Excellent customer service skills required.

Minimum License Requirement :

California RN license.

Delivering world-class health care one patient at a time.

Pay Range: