California Licensed Concurrent Review Nurse

A company is looking for a Concurrent Review Nurse (RN). Key Responsibilities Performs concurrent or post-service review of acute in-patient care services using established criteria Participates in the Utilization Management Care Program Determines medical necessity and benefit coverage based on industry standards Required Qualifications, Training, and Education Current unrestricted license as a Registered Nurse issued by the State of California Associate's degree in Nursing with a minimum of three years of experience in an acute care setting, or a Bachelor's degree with one year of relevant experience Knowledge of Utilization Management and/or Case Management principles and practices Understanding of Medi-Cal and related policies and Title 22 regulations Experience in evaluating electronic medical records and healthcare data

Mar 28, 2025 - 05:03

A company is looking for a Concurrent Review Nurse (RN). Key Responsibilities Performs concurrent or post-service review of acute in-patient care services using established criteria Participates in the Utilization Management Care Program Determines medical necessity and benefit coverage based on industry standards Required Qualifications, Training, and Education Current unrestricted license as a Registered Nurse issued by the State of California Associate's degree in Nursing with a minimum of three years of experience in an acute care setting, or a Bachelor's degree with one year of relevant experience Knowledge of Utilization Management and/or Case Management principles and practices Understanding of Medi-Cal and related policies and Title 22 regulations Experience in evaluating electronic medical records and healthcare data