Registered Nurse:Utilization Review,16:00:00-04:30:00

Acute Hospital Experience by SpecialtyPediatrics* ICU MS Case Management/Utilization ReviewPre-Cert Review* Prior Authorizations* Retrospective Review* Admission Criteria Care coordination Concurrent Review Continued Stay Reviews Determine Medical Necessity per Evidence-Based Guidelines Disease management Plan of Care Utilize InterQual Criteria Utilization ReviewPre-Cert Review* Prior Authorization* Retrospective Review* Admission Criteria Concurrent Review Continued Stay Reviews CPT (Current Procedural Terminology) coding and billing Medical Necessity Utilize InterQual Criteria Work SettingsAcute Hospital Ambulatory RegulatoryCMS: Centers for Medicare and Medicaid Services CPT (Current Procedural Terminology) coding and billing Department of Health DRG (Diagnosis Related Groups) HIPAA guidelines (Health Insurance Portability and Accountability Act) The Joint Commission/ Core Measure/National Safety Goals Additional SkillsRemote UR work CA and Medi-Cal experience/knowledge*