Your Role

The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse, Senior will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information provided by the facilities to determine medical necessity when our members admit. This role will also be involved with discharge planning and transfers as needed for higher levels of care or out of network admissions.

Your Knowledge and Experience

• Requires a current California RN License
• Requires at least 5 years of prior relevant experience
• Bachelor of Science in Nursing or advanced degree preferred
• Strong communication and computer navigation skills is preferred
• Strong teamwork and collaboration skills is preferred
• Independent motivation and strong work ethic is preferred
• Strong critical thinking skills is preferred

Pay Range:

The pay range for this role is: $89,100.00 to $133,650.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.