California Licensed Utilization Review Nurse
Company: VirtualVocations
Location: Saint Charles
Posted on: February 1, 2025
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Job Description:
A company is looking for a Utilization Review Nurse to ensure
high-quality care for health plan members.
Key Responsibilities
Conduct utilization management activities in line with health plan
policies and regulations
Identify and report Potential Quality Issues and support Provider
Dispute Resolution processes
Complete additional duties as assigned
Required Qualifications
BSN or MSN degree
Current valid California RN license
Two or more years of experience in utilization management,
preferably in Medicare Advantage or managed care
Knowledge of Medicare Advantage regulatory guidelines and CMS
regulations
Experience with Potential Quality Issues identification and
reporting
Keywords: VirtualVocations, Jefferson City , California Licensed Utilization Review Nurse, Healthcare , Saint Charles, Missouri
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