UM Nurse Reviewer- Bakersfield 1.2

This full-time, hourly position is for a Clinical Nurse Reviewer for a specific population (likely a care setting within a healthcare organization). The role focuses on timely review of pre-certification/concurrent requests, ensuring proper medical necessity, efficient discharge planning, and collaboration with internal/external stakeholders to meet regulatory and Medicare guidelines. The position involves utilizing clinical judgement and medical knowledge to make accurate determinations and support high-risk member care. This is a 'non-exempt' position.

Requirements

• Active Unrestricted Current California RN or LVN license
• At least one year of managed care experience
• Proficient in PC Software computer skills
• ICD-10, CPT coding knowledge/experience preferred
• Medicare guidelines, InterQual, or MCG knowledge/experience preferred
• Excellent communication skills (verbal and written)
• Solid problem solving and analytical skills
• Ability to interact productively with individuals and with multidisciplinary teams
• Planning, organizing, conflict resolution, and essential interpersonal skills

Benefits

• Medical
• Dental
• Vision
• Simple IRA Plan with Employer Contribution
• Employer Paid Life Insurance
• Employee Assistance Program