Utilization Review (Sacramento)

Utilization Review (Sacramento)

07 Feb 2019

Utilization Review (Sacramento)

Currently hiring for full-time a Utilization Review Nurse for a well-established health care company. This position are located in the greater Sacramento area and pay is based on experience. Responsibilities include, but are not limited to the following:Responsibilities include, but are not limited to the following:* Responsible for managing a continuum of care from admission through discharge for assigned patients either inpatient or outpatient.* Partners with medical staff, utilizes scientific evidence for best practices, relevant data and compliance with the mission/philosophy, standards, goals and core values. * Proactively assesses all potential case management and CCS member cases identified from either external or internal sources and actively manages all high risk, high volume cases throughout the continuum of the member's health care needs or until they reach a maintenance mode.* Demonstrates a multidisciplinary approach in identifying problems, communication and negotiating with the member's PCP, family members, caregivers, other members of the health care team, community resources and the Health Plans.* Researches and refers members to sources for alternative funding, community services and other services which may provide support to the patient and family.* Tracks all CCS referrals for timely notification of decisions. Assists Medical Director with CCS appeals as applicable.* Coordinates care for CCS members between PCP, CCS providers and other physicians and providers as needed as applicable.* Identifies cases for possible peer reviewers to evaluate the appropriateness and necessity of care and or quality of care concerns. Qualifications:* Graduated from an accredited school of nursing* Active CA RN/LVN License* Two years utilization/case management experience in the managed care industry a plus* Word processing and computer experience required. If interested and qualified, please forward your resume to abarber@aerotek.com for consideration. About AerotekOur people are everything. For more than 30 years, Aerotek Inc. has distinguished itself as a leader in recruiting and staffing services by having a deep understanding of the intersection of talent and business. As a strategic partner to more than 17,000 clients and 300,000 contract employees every year, Aerotek's people-focused approach yields competitive advantage for its clients and rewarding careers for its contract employees. Headquartered in Hanover, Md., Aerotek operates a network of over 230 non-franchised offices with more than 6,000 internal employees dedicated to serving our customers. To learn more, visit Aerotek.com.

Related jobs

  • The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Clinical Review Nurse to conduct clinical reviews of grievances and appeals filed by members and providers. Clinically evaluates reports of Potential Quality Incidents

  • Currently hiring for full-time Claims Review Specialists for a well-established healthcare company. These positions are located in the greater Sacramento area and pay is based on experience. Responsibilities include, but are not limited to the follow ...

Job Details

Jocancy Online Job Portal.