What are the responsibilities and job description for the Utilization Management & Quality Review Nurse position at UCLA Health Careers?
Description
As the Utilization Management & Quality Review Nurse, you will be responsible for:
- Ensuring appropriate, cost-effective, and high-quality care for New Century Health Plan members
- Conducting utilization management (UM) activities in accordance with health plan policies and regulatory guidelines
- Identifying and reporting Potential Quality Issues (PQI) and supporting Provider Dispute Resolution (PDR) processes to ensure compliance and foster provider satisfaction
- Completing other duties as assigned
Salary Range: $61.79 - $79.91/hourly
Salary : $1,000 - $1,000,000
