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Registered Nurse Coordinator, Utilization Management
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- contract to perm opening at one of Yoh’s clients in Fairfield, CA.What You Will Be Doing:Conducts retrospective claims review, either in the aggregate or on an individual basis.
- Provides summaries of findings to the Team Manager UM.Evaluates appropriateness of care through interpretation of benefits as outlined in Title 22, Medi-Cal Provider Manual, DMHC and/or CMS regulatory requirements and PHC policies and procedures for each product line.
- Documents and maintains patient-specific utilization management records in the database and files.
- Works with other PHC departments to resolve issues relating to the authorization of medical services.
- Performs inter-rater reliability audits as directed by the department manager.
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