APR Consulting, Inc. has been engaged to identify an Nurse Coordinator . Location: Los Angeles, CA 90045 Position: Nurse Coordinator Pay Rate: $63/hr Duration: 2 month contract with probable extension Expected Shift: 8am-5pm, 40hrs/week JOB SUMMARY Utilization Review Nurse Remote 2 month contract with probable extension Job Description: Ensuring appropriate, cost-effective, and high-quality care for New Century Health Plan members Conducting utilization management (UM) activities in accordance with health plan policies and regulatory guidelines Identifying and reporting Potential Quality Issues (PQI) and supporting Provider Dispute Resolution (PDR) processes to ensure compliance and foster provider satisfaction Completing other duties as assigned Qualifications: A BSN or MSN degree, required Current valid California RN license, required Two or more years of experience in utilization management, preferably in Medicare Advantage or managed care Knowledge of Medicare Advantage regulatory guidelines, including CMS regulations Experience with Potential Quality Issues (PQI) identification and reporting Familiarity with Provider Dispute Resolution (PDR) processes Strong clinical assessment and critical thinking skills Proficiency in electronic health records (EHR) and utilization management software Excellent written and verbal communication skills This particular client is requiring that all new hires show proof of vaccination. However, accommodations may be made for those with disabilities or religious reasons who cannot obtain a vaccine. We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. Don't miss out on this amazing opportunity! If you feel your experience is a match for this position please apply today and join our team. We look forward to working with you! #J-18808-Ljbffr APR Consulting, Inc
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