Utilization Review - Managed Care Nurse

  • 432531
  • Registered Nurse
  • March 07, 2019
  • 4 Hamilton Landing Suite 100
  • Novato, CA 94949
  • 8 D
  • 13 Weeks
  • May 04, 2019
  • Onward
  • Temporary
  • $1,774 - $1,955*
  • *Estimate of weekly payments is intended for informational purposes and includes hourly wages, as well as reimbursements for meal & incidental expenses and housing expenses incurred on behalf of the Company. Please speak with your Recruiter for additional details.

Job Description & Requirements

Utilization Review - Managed Care Nurse

Principle Accountabilities *Review routine referral/service requests on assigned patients in accordance with NCQA timeliness standards and health plan benefit structure. *Prepares and presents cases for medical director review in a concise, objective and organized manner. * Assists with identifying patterns and trends and develops and implements corrective actions when necessary. *Educates and supports members in the accessing care using their HMO and Medicare Advantage benefits as needed. * Review routine referral/service requests on assigned patients in accordance with NCQA timeliness standards and health plan benefit structure. * Identifies and refers patients to disease management, wellness programs and community resources whenever relevant. *Assesses members’ physical, psychological, social, environmental, financial and functional status as necessary and informs the patient’s treating physician of clinically relevant findings e.g. positive score of depression screening, non-compliance with the plan of care and barriers t treatment. *Collaborates with the concurrent review.

Required Qualifications

CA RN LIC Must have Utilization Review Experience This position coordinates utilization review and case management activities for commercial and Medicare enrollees. The Utilization review nurse is knowledgeable about the Nurse Practice Act, NCQA, Millman Care Guides, and the Center for Medicare and Medicaid, HMO timeliness rules and pertinent state and federal regulations.

Preferred Qualifications

Experience strongly preferred in one or more of the following: HMO, Health plan, Medicare, Utilization Management, Case Management

Facility Location


Job Benefits

Onward Healthcare's travel nursing assignments typically last 13 weeks, and include:

  • Competitive pay rates and comprehensive benefits
  • Medical plans with dental and vision
  • Complimentary, high-quality private housing
  • 401(k) and flex spending options
  • Life insurance
  • Accident and short-term disability coverage
  • Free continuing education (CE) courses
  • Travel allowances
  • Guaranteed pay program
  • Tuition discount program
  • Referral bonuses

About the Company

Onward Healthcare, an AMN Healthcare company, is a travel nursing company dedicated to moving our nurses careers "onward and upward." Our team of expert recruiters connect clinicians with exclusive travel nursing opportunities at the nation’s top hospitals and healthcare facilities. Onward's nursing assignments are part of a larger, comprehensive RN career development and consultation service. Onward/AMN Healthcare is an EEO/AA/Disability/Protected Veteran Employer.

  • Facebook
  • Twitter
  • LinkedIn

Travel nurse jobs, staffing and recruitment from Onward Healthcare. © 2018 AMN Healthcare, Inc. All rights reserved. Reproduction and distribution of these materials is prohibited without the expressed written authorization of AMN Healthcare, Inc.