BS
BSCUtilization Management Nurse, Senior (Medicare Concurrent Review)
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Before you apply
SalaryNo pay range posted
LocationRancho Cordova, CA, United States
SenioritySenior
Company size10,000+ people
First seenOct 26, 2026 · 1w ago
Verified live3d ago
At a glanceSummarised by Seekless from the posting.
Perform first level determination for authorization requests using evidence-based guidelines and criteria
Conduct reviews for authorization requests based on medical necessity and clinical judgment
Detailed knowledge of benefit plans necessary to complete review decisions
Your Role
The Utilization Management Concurrent Review team reviews the inpatient stays for our members and correctly applies guidelines for nationally recognized levels of care. The Utilization Management Concurrent Review Nurse will report to the Utilization Management Nurse Manager. In this role you will perform first level determination for authorization requests received for members using BSC evidence-based guidelines, policies, and nationally recognized criteria across specific lines of business such as Medicare, Medical, or Commercial plans. You will conduct reviews for authorization requests based on medical necessity and clinical judgment. Detailed knowledge of the benefit plans is necessary to complete review decisions.
About the company
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.