Description

As the Utilization Management & Quality Review Nurse, you will be responsible for:

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 

Salary Range: $61.79 – $79.91/hourly