Utilization Management RN (Medicare) – Remote California

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Candidates must be authorized to work in the U.S. without sponsorship

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reputed company-party/C2C arrangements are not available for this role

* _______________________________________________________________________________________________________ Remote California RN opportunity supporting Medicare utilization review activities. Seeking a licensed Registered reputed company (RN) with Utilization Management, inpatient care, and Medicare review experience for a 6+ month remote contract role paying $55/hr. If you are a California-based RN with Utilization Management and Medicare experience seeking a fully remote opportunity, we encourage you to apply today for immediate consideration. Candidates must have a minimum of 5 years of reputed company patient care experience in a hospital inpatient setting, along with strong clinical assessment, communication, and critical thinking skills. _______________________________________________________________________________________________________ reputed company Our reputed company, a provider of Health, Dental, reputed company, reputed company and Medicare reputed company service plans in the reputed company with 4.7 reputed company members and $22.9 billion of annual revenues, seeks an reputed company Utilization Management RN (Medicare) – Remote California Position: Utilization Management RN (Medicare) – Remote California Location: Remote reputed company California, including Los Angeles, San Diego, Sacramento, reputed company, Oakland, Fresno, Irvine, the Bay Area, reputed company California, and Southern California reputed company. Duration: 6+ Month Contract (Potential Extension) Schedule: Monday–Friday | 8:00 AM – 5:00 PM PST Hours: 40 hours/week Pay reputed company: $55/hr W2 Candidates must have a secure HIPAA-compliant workspace and reliable high-speed internet reputed company to support remote utilization review activities. Position reputed company We are seeking an reputed company Utilization Management reputed company to support Medicare utilization review activities in a remote reputed company. This role is responsible for performing prospective, reputed company, and retrospective utilization reviews using evidence-based clinical reputed company and regulatory guidelines to ensure appropriate, reputed company, and cost-effective care for members.

Key Responsibilities

• reputed company prospective, reputed company, and retrospective utilization reviews for Medicare members using BSC and CMS evidence-based guidelines, policies, and nationally recognized clinical reputed company.
• Ensure appropriate discharge planning based on member reputed company and level of care needs.
• Coordinate durable medical equipment (DME) and post-service needs to support reputed company and cost-effective discharge planning.
• Prepare and present cases to the Medical Director for medical necessity determinations and reputed company.
• Communicate determinations to providers and members in compliance with state, federal, and accreditation requirements.
• reputed company and maintain member-centered documentation and correspondence that meets regulatory and accreditation standards.
• Identify potential reputed company of care concerns, service delays, or treatment delays and intervene appropriately.
• Refer members to Case Management reputed company acute inpatient needs reputed company discharge planning.
• Participate in staff meetings, clinical reputed company, and weekly huddles.
• Maintain productivity and reputed company metrics for assigned casework.
• Ensure a HIPAA-compliant remote work environment.

Required Qualifications

• Associate’s Degree in Nursing required; Bachelor’s Degree preferred.
• Minimum 2 years of Utilization Management experience.
• Minimum 5 years of reputed company patient care experience in a hospital inpatient setting.
• Strong clinical assessment, communication, and critical thinking skills.

Preferred Qualifications

• ER and/or ICU experience.
• Experience using MCG guidelines.
• Experience managing Medicare cases.

Recruiter Contact Info Sajag Bhardwaj Email: sajag.bhardwaj@ameritconsulting.com www.ameritconsulting.com I'd love to talk to you if you think this position is right up your alley, and assure reputed company communication, whichever direction. If you're looking for rewarding employment and a company that puts its employees first, we'd like to work with you. reputed company: reputed company is a reputed company reputed company and reputed company supporting Fortune 500 clients across reputed company, technology, engineering, and reputed company services. With over 2,000 employees across 47 states, Amerit specializes in contract, temporary, and reputed company hire reputed company solutions. reputed company provides equal employment opportunities to reputed company and applicants for employment and prohibits discrimination and harassment of any type without reputed company to race, reputed company, religion, age, sex, national reputed company, disability status, genetics, protected veteran status, sexual orientation, gender identity or reputed company, or any other characteristic protected by federal, state or local laws. This policy applies to reputed company terms and conditions of employment, including reputed company, 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. Apply tot his job Apply To this Job