Utilization Review Nurse

We are seeking a detail-oriented and experienced UR Nurse for a 13-week travel assignment in Santa Rosa California. This position requires strong UR experience, exceptional accuracy, and the ability to work efficiently in a fast-paced environment using computerized systems.

REQUIRED SKILLS

Primary (Must-Have): 3-year acute medical Care Manager/UM experience performing utilization review in a hospital setting (not health plan/medical group) InterQual required, this is a Hardstop Experience with HMOs, IPAs, etc. Experience with Medicare regulations, regarding specific UM processes, such as CC44s, ABNs, HINNs, MCSNs, etc. Proficient with Epic, recent use required within the last 6-12 months For those candidates staffing the centralized UM team, these are also some additional things we require:

1. Every third weekend rotation for the length of contract.
2. FLEXIBILITY – our team supports three facilities and our caregivers will rotate between all three.
3. Must work in Pacific Standard Time.
4. Strict adherence to all CA labor laws regarding lunches, breaks etc. as well as -

a. ZERO overtime unless approved by leadership prior to end of shift. b. ZERO working off the clock

ROLES & RESPONSIBILITIES

Care coordination* Concurrent Review* Data Abstraction* Determine Medical Necessity per Evidence-Based Guidelines* Disability case management* Disease management* Needs Assessment/ Order DME* Plan of Care* Pre-Cert Review* Prior Authorizations* Utilize Milliman Guidelines* Worker’s comp case management* Admission Criteria*

SHIFT DETAILS

Schedule: Day Shift Shift Hours: Day shift Weekly Hours: 40 Hours Shifts Per Week: 5 x 8-Hour Shifts Guaranteed Hours: Facility Guidelines Apply On-Call Requirement: None Floating Requirement: None Block Scheduling: Not Available

BENEFITS

Medical | Dental | Vision | 401(k) Travel Benefits Package Available (if applicable)

EEOC COMPLIANCE

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, veteran status, or any other protected status.

DISCLAIMER

Final hiring decisions are based on candidate qualifications, education, experience, and facility requirements. Candidates must meet all compliance standards prior to assignment start. COVID-19 and Flu vaccination requirements apply, with approved medical or religious exemptions accepted per facility policy. #J-18808-Ljbffr Pacer Group