RN Utilization Mgmt, Full-Time Day
On-siteCarson, California, United States
Job Summary
Coordinate e-TAR processes, denials management, and insurance authorizations for Medi-Cal patients and observation stays. Conduct daily reviews of patient charts to justify medical necessity, discharge planning, and continued stay appropriateness. Manage documentation for inpatient admissions and collaborate with interdisciplinary teams to facilitate timely care and minimize adverse outcomes. Report e-TAR progress and delays to leadership while participating in revenue meetings and quality improvement plans. Requires current California RN license, 3-5 years in case management or utilization management, and experience with MCG and Interqual.
Required Qualifications
- Associates Degree in Nursing
- Minimum 3-5 years recent experience in Case Management or Utilization Management or Prior Authorization
- Current California Registered Nurse License
- Experience in MCG and/or Interqual
- Current Basic Life Support (BLS)
- Highly organized and well developed oral and written communication skills
- Confidence to communicate and outreach to other community health care organizations and personnel
- Demonstrates sound judgment, decision making and problem solving skills
Desired Qualifications
- BSN
- Certification in UM or CM
- Bilingual language skills (Spanish)
- Basic computer skills
- CCM Certification
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