Nurse RN 3

Duration: 6+ months | Possible extension (Contract to Hire/ Temp to Perm)

Shift: 8am to 5pm PST Monday - Friday.

Location: Remote CA

PR: XXXX-48.00/hr

Day-to-day responsibilities:

• Perform prospective, concurrent, and retrospective utilization reviews and first level determination approvals for members using CMS evidenced based guidelines, policies and nationally recognized clinical criteria for the Medicare line of business.
• Ensure discharge planning at appropriate levels of care for the members' needs and acuity.
• Durable medical equipment, and post service needs to ensure quality and cost-appropriate DC planning.
• Prepare and present cases to Medical Director for oversight/necessity determination and communicate determinations to providers and members to comply with state, federal and accreditation requirements.
• Develop and review member centered documentation and correspondenc...