Utilization Review Nurse
APR Consulting, Inc. has been engaged to identify an Nurse Coordinator
Location: Los Angeles, CA 90045
Position: Nurse Coordinator
Pay Rate: $63/hr
Duration: 2 month contract with probable extension
Expected Shift: 8am-5pm, 40hrs/week
JOB SUMMARY
Utilization Review Nurse
Remote
2 month contract with probable extension
Job Description:
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
We’re seeking a highly qualified candidate with:
• A BSN or MSN degree, required
• Current valid California RN license, required
• Two or more years of experience in utilization management, preferably in Medicare Advantage or managed care
• Knowledge of Medicare Advantage regulatory guidelines, including CMS regulations
• Experience with Potential Quality Issues (PQI) identification and reporting
• Familiarity with Provider Dispute Resolution (PDR) processes
• Strong clinical assessment and critical thinking skills
• Proficiency in electronic health records (EHR) and utilization management software
• Excellent written and verbal communication skills
Our client is the one of the largest Healthcare Staffing Provider in the United States, to be assigned at one of their affiliated hospitals/healthcare facilities.
This particular client is requiring that all new hires show proof of vaccination. However, accommodations may be made for those with disabilities or religious reasons who cannot obtain a vaccine.
Since 1980 APR Consulting, Inc. has provided professional recruiting and contingent workforce solutions to a diverse mix of clients, industries, and skill sets nationwide.
We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
Don't miss out on this amazing opportunity! If you feel your experience is a match for this position please apply today and join our team. We look forward to working with you!
APR Consulting, Inc., is one of the most trusted talent acquisition and workforce solutions providers in the United States. Known for exceptional responsiveness, agile strategies, and consistently high-level talent, the firm has become a go-to for organizations and managed services providers navigating complex change and urgent challenges. Since its founding in 1980, APR has transformed from a California IT-focused staffing firm to a full-service solutions provider filling a wide range of positions and serving over eight industries — including aerospace and defense, healthcare, IT, telecom, hospitality/gaming, sports/entertainment, government, and utilities –– in all 50 states, with a loyal roster of more than 850 specialized professionals.