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Intensive Case Management - Medicare Advantage Utilization Review Nurse (flexible-hybrid)
DescriptionUnder the direction of the Assistant Director, the ICM Medicare Advantage Utilization Review Nurse performs utilization review of medical necessity and appropriateness, cost containment and efficiency, compliance with regulations and contracts, care coordination and continuity of care, prior authorization and denial management, education and provider support, and data and quality reporting for referrals for Medicare Advantage population enrolled under UCLA Medical Group. The ICM Medicare Advantage Utilization Review Nurse ensures that home health and durable medical equipment services are cost effective, timely, and compliant. This position is a
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