• Utilization Management Nurse

    Insight Global (Campbell, CA)


    Job Description

    - Review approximately 60 medical authorization requests per day

     

    - Evaluate medical necessity for procedures and care requests

     

    - Use internal Access Express system to document reviews

     

    - Apply specific health plan guidelines and policies

     

    - Review clinical notes and identify key medical criteria

     

    - Communicate with doctor's offices to obtain additional information when needed

     

    - Meet strict turnaround times (24-72 hours for most authorizations)

     

    - Collaborate with medical directors on case determinations

     

    We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to [email protected] learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

     

    Skills and Requirements

     

    - Current California RN or LVN license

     

    - Clinical hospital experience (minimum 2 years preferred)

     

    - Strong critical thinking and clinical judgment skills

     

    - Ability to work 8am-5pm Pacific Standard Time

     

    - Proficiency in reviewing medical documentation and applying health plan guidelines

     

    - Experience with Utilization Management (UM) - Knowledge of commercial, Medicare, and Medi-Cal HMO lines of business

     

    - Health plan experience

     

    - Prior experience working with health plan portals