What are the responsibilities and job description for the Utilization Management RN Lead position at Blue Shield of California?
Company Overview
">Blue Shield of California is a non-profit health plan that has been serving Californians for over 80 years. We are committed to providing high-quality healthcare services to our members and improving the health and well-being of Californians.
">Job Description
">This position requires a highly skilled and experienced Utilization Management Nurse to join our team. The successful candidate will have strong clinical knowledge and excellent communication skills, with the ability to work effectively in a fast-paced environment.
">Responsibilities
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- Review clinical information provided by facilities to determine medical necessity for member admissions. ">
- Perform utilization reviews and first-level determination approvals for members using BSC evidence-based guidelines and policies. ">
- Communicate with Medical Directors and other stakeholders to ensure compliance with regulations and accreditation standards. ">
- Develop and review member-centered documentation and correspondence reflecting determinations. ">
Requirements
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- Bachelor's of Science in Nursing or advanced degree. ">
- Current California RN License. ">
- Strong communication and computer navigation skills. ">
Benefits
">Blue Shield of California offers a comprehensive benefits package, including medical, dental, and vision coverage, as well as retirement savings options and professional development opportunities.
