UM Nurse Reviewer, RN - Bakersfield 1.1
Universal Healthcare MSO LLCBakersfield, California, United States
Posted December 24, 2025
62000 - 108360 USD year
Full Time
About the Company
Universal Healthcare MSO LLC operates as a managed care organization in Kern County, providing a network of primary, specialty, and urgent care services. The company supports healthcare providers through case management, a provider portal, and administrative services to deliver comprehensive care to residents.
Job Description
The UM Nurse Reviewer will conduct timely reviews of pre-certification and/or concurrent requests, aligning with established policies, and ensuring that members receive suitable care at the right time and location.
Requirements
- Perform utilization review activities, including pre-certification, concurrent, and/or retrospective reviews according to regulatory guidelines.
- Review proposed hospitalization, home care, and inpatient / outpatient treatment plans for medical necessity and efficiency in accordance with CMS coverage guidelines.
- Determine medical necessity of each request by applying appropriate medical criteria to designated level reviews and utilize approved evidenced-based guidelines or criteria.
Benefits
- Medical
- Dental
- Vision
- Simple IRA Plan with Employer Contribution
- Employer Paid Life Insurance
- Employee Assistance Program
