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$35/hr | Utilization Management Nurse Specialist | Professional Development!

HB Staffing

Position: Utilization Management Nurse Specialist  

Location: Huntington Beach, CA   

Pay: $35/hr  

Experience: 3 years of utilization management experience in a managed care setting; 2 years of clinical nursing experience; experience with medical decision support tools (i.e., InterQual, NCDs, LCDs) and government sponsored managed care programs

Education: Graduated from an Accredited School of Nursing; Bachelor’s degree in Nursing preferred; Active California LPN/LVN or RN license; Active California LPN/LVN or RN license

Type: Full-time; Contract 

Schedule: Monday – Friday, Day Shift (remote, must be commutable to Orange County or LA)

 

HB Staffing is seeking a Utilization Management Nurse Specialist to join a growing and dynamic team!  

Job Description: 

  • Facilitate, coordinate and approve medically necessary referrals that meet established criteria
  • Assure timely and accurate determination and notification of referrals and reconsiderations based on the referral determination status
  • Generate approval, modification and denial communications, to include member and provider notification of referral determination
  • May perform telephonic and/or on-site admission and concurrent review; collaborate with onsite staff, physicians, providers, member/family interaction to develop and implement a successful discharge plan
  • Acts as a department resource for medical service requests /referral management and processes
  • Answers all inquiries in a professional and courteous manner; provide resolution steps
  • Educate providers on utilization and medical management processes
  • Provide clinical knowledge and function as a clinical resource to non-clinical team staff
  • Research and validate accuracy of lapsed authorization data with staff and provide reports summarizing results contracted providers
  • Assist with training for new hires and continued development of existing staff

Position Requirements: 

  • Strong organizational, task prioritization and delegation skills
  • Must be patient advocacy focused
  • Manage regulatory timelines to ensure department compliance with State and other regulatory contracts
  • Knowledge of basic computer applications (such as Microsoft Office Suite) with the ability to adapt to new software programs
  • Strong communication skills
  • Excellent typing and writing skills
  • Active driver’s license in good standing preferred
  • Knowledge of utilization management principles and healthcare managed care

 

HB Staffing does not just connect you with a job; we offer a Professional Mentoring & Education Program to help you be great at your job, love it, and grow.  

 

HB Staffing is part of Array Corporation, the leading technology-enabled workforce solutions company whose mission is to fix how labor is bought, sold and delivered to enable universal access to the American Dream. 

 

We are proud to be an Equal Employment Opportunity and Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. 

Quick Apply

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Accepted file types: .docx and .pdf