RN / Addictions Nursing / California / Any / Utilization Management Jo (Visalia)

Blue Shield of California in Visalia, CA

  • Industry: Healthcare - Nursing - Registered Nurse (RN/BSN/ASN)
  • Type: Full Time
  • Compensation: $102,700.00 - 151,210.00 / Year*
Utilization and Medical Review - Ensures accurate and timely prior authorization of designated healthcare services, concurrent review activity, and retrospective review activity. Utilization Management Nurse - Performs prospective, concurrent and retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare and FEP.Reviews for medical necessity, coding accuracy, medical policy compliance and contract compliance. Clinical judgment and detailed knowledge of benefit plans used to complete review decisions.
Associated topics: asn, cardiothoracic, care, coronary, hospice, infusion, intensive, mhb, psychiatric, registed

* Estimated salary


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