Intensive Case Management - Medicare Advantage Utilization Review Nurse (flexible-hybrid) at UCLA Health

Required: BSN or MSN degreeActive CA RN LicenseMinimum of 2 years’ experience in utilization management, Inpatient CM or clinical Experience.Strong knowledge of CMS guidelines, home health coverage criteria, and DME regulations. Proficient in clinical documentation review, critical thinking and evidence-based decision making. Familiarity with utilization platforms and electronic health records. Must have strong problem-solving skills.  Ability to analyze problems and formulate plans, solutions and a course of action given changing circumstances. Excellent organizational and time management skills, including the ability to handle multiple conflicting priorities simultaneously. Strong ability to prioritize. Demonstrate proficiency in computer skills such as Windows computer function, computer navigation, and ability to use computerized patient care systems. Competence in navigating the internet/intranet and use of browser software such as Microsoft Explorer and applications such as  Excel, Word, and PowerPoint Excellent interpersonal, verbal and written communication skills.      Ability to articulate clinical and non-clinical information to individuals of all levels of understanding. Ability to be flexible and work according to availability of office personnel, patient and resources required to coordinate care of patient. Apply Now