Utilization Management & Quality Review Nurse in Los Angeles, CA for UCLA

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David Geffen School of Medicine at UCLA

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Utilization Management & Quality Review Nurse

DescriptionAs the Utilization Management & Quality Review Nurse, you will be responsible for:Ensuring appropriate, cost-effective, and high-quality care for New Century Health Plan membersConducting utilization management (UM) activities in accordance with health plan policies and regulatory guidelinesIdentifying and reporting Potential Quality Issues (PQI) and supporting Provider Dispute Resolution (PDR) processes to ensure compliance and foster provider satisfactionCompleting other dutie

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