Utilization Management Clinical Quality Nurse Reviewer RN II

Utilization Management Clinical Quality Nurse Reviewer RN II conducts and tracks targeted and random internal department documentation audits to ensure UM practices and supporting documentation are compliant with all regulatory requirements.

Requirements

• At least 5 years of experience in Clinical Nursing
• Minimum of 2 years of auditing clinical documentation
• Active participation in at least two state regulatory audits and one federal regulatory audits
• Previous experience with Medi-Cal and Medicare in a managed care environment and experience with mitigation planning and implementation

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)