Iehp
From Iehp's careers page
Status: listed on the employer's own careers page when we last checked (daily). Confirm on their site before applying.
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.
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more
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
A minimum of two (2) years of direct, hands‑on clinical patient care experience in an acute care facility utilizing an active RN license is required.
Experience in an HMO or experience in a Managed Care setting preferred
High school diploma or GED required
Bachelor's degree in nursing from an accredited institution preferred
Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
Nationally recognized UM criteria.
Title 22, Title 10, DMHC, DHCS, CMS, and state regulatory requirements specifically as they relate to UM/Health Plan correspondence.
Clinical nursing practice, standards of care, and medical terminology
Medical necessity standards and benefit interpretation.
Clinical assessment and documentation skills. Skills in documenting UM referral reviews accurately.
Communication skills (both written and verbal).
Critical thinking skills.
Abstracting and interpreting medical information from clinical records.
Express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.
Manage caseload efficiently.
Exhibit a high attention to detail.
Work at a high level of speed while maintaining accuracy.
Work well with both physicians and nursing staff.
Start your journey towards a thriving future with IEHP and apply TODAY!
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