[Hiring] Utilization Management Nurse @Inland Empire Health Plan

Role Description

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

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 met.
• 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.

Qualifications

• A minimum of two (2) years of direct, hands‑on clinical patient care experience in an acute care facility utilizing an active RN license is required.
• Experience in an HMO or Managed Care setting preferred.
• High school diploma or GED required.
• Bachelor's degree in nursing from an accredited institution preferred.
• Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required.

Requirements

• Strong knowledge and understanding of nationally recognized UM criteria.
• Title 22, Title 10, DMHC, DHCS, CMS, and state regulatory requirements specifically as they relate to UM/Health Plan correspondence.
• Clinical nursing practice, standards of care, and medical terminology.
• Medical necessity standards and benefit interpretation.
• Strong proficiency in clinical assessment and documentation skills.
• Communication skills (both written and verbal).
• Critical thinking skills.
• Abstracting and interpreting medical information from clinical records.
• Ability to express or exchange ideas to impart information to the public and convey detailed instructions to staff accurately and quickly.
• Ability to manage caseload efficiently.
• Exhibit a high attention to detail.
• Work at a high level of speed while maintaining accuracy.
• Work well with both physicians and nursing staff.

Benefits

• Competitive salary.
• Telecommute schedule.
• State of the art fitness center on-site.
• Medical Insurance with Dental and Vision.
• Life, short-term, and long-term disability options.
• Career advancement opportunities and professional development.
• Wellness programs that promote a healthy work-life balance.
• Flexible Spending Account – Health Care/Childcare.
• CalPERS retirement.
• 457(b) option with a contribution match.
• Paid life insurance for employees.
• Pet care insurance.

Company Description

Start your journey towards a thriving future with IEHP and apply TODAY!

Work Model Location: Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership).

Pay Range: USD $91,249.60 - USD $120,910.40 /Yr.