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4 Remote Utilization Management Nurse Jobs in Long Beach, CA

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SPECTRAFORCE
Long Beach, CA | Full Time
$82k-102k (estimate)
2 Months Ago
Molina Healthcare Group
Long Beach, CA | Full Time
$153k-173k (estimate)
3 Weeks Ago
Morgan Stephens
Long Beach, CA | Full Time
$109k-141k (estimate)
1 Month Ago
Morgan Stephens
Long Beach, CA | Full Time
$117k-153k (estimate)
3 Months Ago
Remote Utilization Management Nurse
SPECTRAFORCE Long Beach, CA
$82k-102k (estimate)
Full Time 2 Months Ago
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SPECTRAFORCE is Hiring a Remote Remote Utilization Management Nurse

Utilization Management Nurse Remote6 monthsRemote in CA8AM-5 PMThe Medicare Member Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Medicare Appeals and Grievances RN Senior will report to the Appeals and Grievances Manager. In this role you will perform accurate and timely clinical review of Member-initiated appeals. The RNs perform first-level appeal reviews for members utilizing the National Coverage Determination (NCD) guidelines, Local Coverage Determination (LCD) Guidelines, Milliman Care Guidelines, and nationally recognized sources such as NCCN and ACOG. The successful RN candidate will review both inpatient and outpatient Medicare member appeals for benefits, medical necessity, coding accuracy and medical policy compliance.
Required
  • Knowledge of Medicare and benefit reviews
  • Requires 2 years of health insurance or related experience.
  • Requires a current CA RN License
  • Demonstrate the ability to act independently using sound clinical judgment
Nice To Have
  • Knowledge of CPT, ICD-10, HCPCS, and billing practices
  • Excellent communication skills
  • Works well in a fast-paced team environment
Note: The Company is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website . Applicants with disabilities may access this notice in an alternative format by contacting NAhr@spectraforce.com .

Job Summary

JOB TYPE

Full Time

SALARY

$82k-102k (estimate)

POST DATE

06/01/2024

EXPIRATION DATE

08/10/2024

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The job skills required for Remote Utilization Management Nurse include Communication Skills, etc. Having related job skills and expertise will give you an advantage when applying to be a Remote Utilization Management Nurse. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Remote Utilization Management Nurse. Select any job title you are interested in and start to search job requirements.

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The following is the career advancement route for Remote Utilization Management Nurse positions, which can be used as a reference in future career path planning. As a Remote Utilization Management Nurse, it can be promoted into senior positions as a Head Nurse - CCU that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Remote Utilization Management Nurse. You can explore the career advancement for a Remote Utilization Management Nurse below and select your interested title to get hiring information.

Molina Healthcare Group
Remote | Full Time
$153k-173k (estimate)
3 Weeks Ago
Morgan Stephens
Remote | Full Time
$109k-141k (estimate)
1 Month Ago
Morgan Stephens
Remote | Full Time
$117k-153k (estimate)
3 Months Ago