UM Nurse, RN
California
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!
Under the general direction of the Utilization Management Manager, the Utilization Management Nurse is responsible for prospective and concurrent/retrospective review of referrals ensuring regulatory requirements are being met as they relate to language readability and appropriate citation of criteria in Member correspondence. This position is responsible to ensure meeting Member’s needs using nationally recognized UM criteria.
Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.
Perks
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.
- Competitive salary
- Telecommute schedule
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development
- Wellness programs that promote a healthy work-life balance
- Flexible Spending Account – Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance
Education & Requirements
- Two (2) or more years of utilization management experience in a health care delivery setting specifically in prior authorization or two (2) or more years of experience in an acute care facility
- Experience in an HMO or experience in a Managed Care setting preferred
- High school diploma or GED required
- Bachelor's degree in Nursing from an accredited institution preferred
- Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
Key Qualifications
- Must have a valid California Driver’s license
- Knowledge of Title 22, Title 10, DMHC, DHCS, and CMS regulatory requirements specifically as they relate to UM/Health Plan correspondence.
- Exhibits a high attention to detail in documenting UM referral reviews
- Ability to work at a high level of speed while maintaining accuracy
- Ability to work well with both physician and nursing staff
Start your journey towards a thriving future with IEHP and apply TODAY!
Pay Range
- $91,249.60 USD Annually - $120,910.40 USD Annually
Working at IEHP is always about helping our members and helping our team members and for me to address anything that they need from me. It’s something that I take pride in every day.
Maynard Mungcal Learning & Development Analyst 2
I love working for IEHP. I really think they not only care about their members, but they also care about their employees … I've been here for eight years, and I just love it!
Mayra Gomez Senior Pharmacy Medication Management Specialist
It’s not just clocking in and clocking out, but being thoughtful and being proud and being an advocate for the work that we do … When people ask me how my day was or how my work is, it’s something that I’m profoundly proud of because I know that I’m making a difference.
Phillip Lo Director of Business Continuity
