What You Can You Expect?
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.
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; we also aim to match our Team Members with the same energy by providing prime benefits and more.
* CalPERS retirement
* 457(b) option with a contribution match
* Generous paid time off- vacation, holidays, sick
* State of the art fitness center on-site
* Medical Insurance with Dental and Vision
* Paid life insurance for employees with additional options
* Short-term, and long-term disability options
* Pet care insurance
* Flexible Spending Account - Health Care/Childcare
* Wellness programs that promote a healthy work-life balance
* Career advancement opportunities and professional development
* Competitive salary with annual merit increase
* Team bonus opportunities
Education & Requirements
* Two (2) or more years of utilization management experience in a health care delivery setting specifically in prior authorization.
* Ortwo (2) or more years of experience in an acute care facility.
* Experience with Commercial Plan Coverage required.
Key Qualifications
* Knowledge of Commercial Plan coverage, Title 10, DMHC, and CMS regulatory requirements specifically as they relate to UM/Health Plan correspondence.
* Knowledge of Commercial Managed Care coverage required.
* 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!
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