Requirements

Ruler HealthCare is probably the biggest relationship of doctors and medicinal services experts in Orange County and Long Beach. Our system gives you loads of access to pros, emergency clinics, gifted nursing, dire consideration and all the more so you have the ideal fit for good wellbeing. The ruler is a piece of OptumCare, a consideration conveyance association that improves tolerant wellbeing and helps make medicinal services work better. 

The Utilization Management RN is liable for looking into demands got from suppliers, utilizing affirmed conventions and criteria (for example State and Federal Law and Regulations Center for Medicare and Medicaid Services (CMS), Pharmacy and wellbeing plan criteria as accessible, Monarch HealthCare Clinical Practice Guidelines, and MCG rules (current release). 

Standard Hours: Mon - Fri from 8 AM - 5 PM. This is an office-based position situated in Irvine, CA. 

Essential Responsibilities: 

• Survey referrals and approvals following set up arrangements and methods as per broadly perceived benchmarks 
• Arrange medicinal services administrations with suitable doctors, offices, contracted suppliers, subordinate suppliers, associated wellbeing experts, subsidizing sources and network assets 
• Create and keep up powerful working connections, with doctors and office staff 
• Organize out - of - arrange and out - of - territory cases with part, wellbeing plans, and Case Management group 
• Go to in - administrations, preparing and gatherings identifying with work errands as coordinated and required