Utilization Management Nurse, Senior- Medicare Concurrent Review
BSCCalifornia, United States • Long Beach, California, United States • El Dorado Hills, California, United States • Lodi, California, United States • Oakland, California, United States • Redding, California, United States • San Diego, California, United States • Los Angeles, California, United States
Posted April 22, 2026
Full Time
About the Company
BSC is an emerging corporate communications firm specializing in strategic messaging, public relations, and media outreach. With a strong focus on developing tailored communication strategies for businesses across various industries, BSC aims to enhance brand visibility and reputation through effective storytelling and impactful campaigns.
Job Description
The Utilization Management Concurrent Review Nurse will perform reviews for authorization requests based on medical necessity and clinical judgment, using BSC evidence-based guidelines and policies. The role requires a strong understanding of benefit plans and the ability to conduct reviews for authorization requests.
Requirements
- Perform prospective, concurrent and retrospective utilization reviews
- Conduct clinical review for medical necessity, coding accuracy, medical policy compliance and contract compliance
- Prepare and present cases to the Medical Director
- Develop and review member centered documentation and correspondence
Benefits
- Paid Time Off
- 401k Matching
- Retirement Plan
- Generous Parental Leave
- Tuition Reimbursement
- Relocation Assistance
