Job Title: RN Utilization Management (UM)/Review
Location: Arcata, California, 95518
Schedule:5X8-40hours/week
Shift:Days
Pay Range: $2300- $2462/week
Key Responsibilities:
- Perform utilization review functions for inpatient, observation, and transitional care patients using InterQual/MCG guidelines.
- Evaluate medical necessity, level of care, and length of stay to ensure appropriate resource utilization.
- Collaborate with providers, case managers, and insurance representatives to support timely and appropriate care decisions.
- Assist in the training, onboarding, and mentoring of new utilization review RNs.
- Provide education and guidance on documentation standards, payer requirements, and clinical review tools.
- Act as a resource for the UR team on complex cases or regulatory questions.
- Participate in audits and quality improvement initiatives related to utilization review.
- Support denial prevention strategies and assist with the appeals process as needed.
Requirements,Education and Certifications:
- Active RN License
- Current BLS certification (AHA),ACLS
- Minimum 2 years of recent Utilization Management experience
Interested? Apply now!
About Pride Health:
Pride Health is Pride Global's healthcare staffing branch, providing recruitment solutions for healthcare professionals and the industry at large since 2010.
Pride Global offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts.
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