UM Nurse, RN (Weekend Shift)

IEHP • California, MD

82d • $91,249 - $120,910 • Remote

About The Position

Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Under the general direction of the Utilization Management Manager, the Utilization Management Nurse is responsible for prospective and concurrent/retrospective review of referrals ensuring regulatory requirements are being met as they relate to language readability and appropriate citation of criteria in Member correspondence. This position is responsible to ensure meeting Member's needs using nationally recognized UM criteria. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Requirements

• Two (2) or more years of utilization management experience in a health care delivery setting specifically in prior authorization or two (2) or more years of experience in an acute care facility.
• High school diploma or GED required.
• Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required.

Nice To Haves

• Experience in an HMO or experience in a Managed Care setting preferred.
• Bachelor's degree in Nursing from an accredited institution preferred.

Responsibilities

• Conduct prospective and concurrent/retrospective review of referrals.
• Ensure regulatory requirements are met regarding language readability and citation of criteria in Member correspondence.
• Meet Member's needs using nationally recognized UM criteria.

Benefits

• Competitive salary
• Telecommute schedule
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account - Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Religious, Grantmaking, Civic, Professional, and Similar Organizations
• Education Level: Bachelor's degree