Utilization Management Nurse, Senior

Your Role

The Federal Employee Program (FEP) team is committed to providing quality healthcare coverage to federal employees, retirees, and their families . The FEP Concurrent Review Utilization Management Nurse will report to the FEP Utilization Management Manager. In this role you will be part of a dynamic team responsible for concurrent and retrospective reviews from inpatient admissions to both acute and lower level of care. You will ensure members receive services at the right level of care at the right time, appropriate, medically necessary, and within their benefit in full collaboration with FEP Care Management. Ultimately contributing to decreasing the cost of healthcare.

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience

• Requires a current California RN License

• Requires at least 5 years of prior relevant experience

• Previous experience in utilization management preferred
• Strong computer skills related to Windows-based programs and applications
• Varied acute care clinical background that includes behavioral health experience
• Must be able to sit for extended periods of time and read clinical information on one computer screen and apply that information based on criteria or policy on a second computer screen to document the decision