Our client, a Medical Center facility under the aegis of a California Public Ivy university and one of largest health delivery systems in California, seeks an accomplished Utilization Review Nurse.
NOTE- THIS IS 100% REMOTE ROLE & ONLY W2 CANDIDATES/NO C2C/1099
*** Candidate must be authorized to work in USA without requiring sponsorship ***
Position: Utilization Review Nurse (Job Id -2698360)
Ensuring appropriate, cost-effective, and high-quality care for New Century Health Plan members
Conducting utilization management (UM) activities in accordance with health plan policies and regulatory guidelines
Identifying and reporting Potential Quality Issues (PQI) and supporting Provider Dispute Resolution (PDR) processes to ensure compliance and foster provider satisfaction
Completing other duties as assigned
We're seeking a highly qualified candidate with:
A BSN or MSN degree, required
Current valid California RN license, required
Two or more years of experience in utilization management, preferably in Medicare Advantage or managed care
Knowledge of Medicare Advantage regulatory guidelines, including CMS regulations
Experience with Potential Quality Issues (PQI) identification and reporting
Familiarity with Provider Dispute Resolution (PDR) processes
Strong clinical assessment and critical thinking skills
Proficiency in electronic health records (EHR) and utilization
Bhupesh Khurana
Lead Technical Recruiter
Email - bkhurana@ameritconsulting.com
Company Overview:
Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally, as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients businesses forward.
Amerit Consulting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
Applicants, with criminal histories, are considered in a manner that is consistent with local, state and federal laws