• Utilization Review/Management Registered Nurse - Woodland Hills office based

    Company: Kelly Services

    Location: Woodland Hills, CA

    Date Posted: September 29, 2013

    Utilization Review/Management RNContract Opportunity - office based in Woodland Hills SUMMARY: Responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. MAJOR JOB DUTIES AND RESPONSIBILITIES:Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources. Works with medical...

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