Posted in Other 30+ days ago.
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Type: Full Time
Location: San Ramon, California
REVIEW NURSE needed for a TEMP-HIRE opportunity with Yoh's client located in San Ramon, CA!
TOP SKILLS SHOULD YOU POSSESS:
* Experience in Utilization Management
* Skilled Nurse Facility or Home Health experience
WHAT YOU'LL BE DOING:
* Perform utilization review of home health services and SNF admissions
* Determine medical necessity and appropriateness of services using clinical review criteria
* Accurately document all review determinations and contact providers and members according to established timeframes
* Appropriately identify and refer quality issues to Medical Management or Medical Director
* Appropriately identifies potential cases for Care Management programs
* Implement and monitor clinical network savings initiatives for the market
* Ensure that the implementation plan and development of the initiatives is sufficient to address the objectives
WHAT YOU NEED TO BRING TO THE TABLE:
* Registered Nurse or Licensed Vocational Nurse with a current and unrestricted California license
* Minimum of two (2) years of direct clinical patient care
* Minimum of one (1) year of experience with medical management activities in a managed care environment, Medicaid managed care preferred; specifically utilization management and/or care management
* Knowledge of managed care principles
* Knowledge of health care resources within the community
* Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual)
* Strong interpersonal, oral and written communication skills
* Possess basic computer skills
WHAT'S IN IT FOR YOU*
We welcome you to be a part of the largest global staffing companies to meet your career aspirations. Yoh's network of client companies has been employing professionals like you for over 65 years in the U.S., UK and Canada. Join Yoh's extensive talent community that will provide you with access to Yoh's vast network of opportunities.
* Medical, Dental & Vision Benefits
* 401K Retirement Saving Plan
* Life & Disability Insurance
* Direct Deposit & weekly EPayroll
* Employee Discount Programs
* Referral Bonus Programs
WHAT ARE YOU WAITING FOR* APPLY NOW!
RECRUITER: Jennifer Andersen
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Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Click here to contact us if you are an individual with a disability and require accommodation in the application process.