Provides guidance on clinical aspects of utilization determinations and develops, initiate, monitor, and integrate utilization management functions for the organization. Gather, analyze, and report utilization and quality of care data through established reporting mechanisms. Graduate of an accredited school of nursing with a current RN license with the California Board of Nursing. Minimum of 5 years experience, including clinical nursing and utilization review/case management in the managed care environment. Professional certification in Utilization Review and/or Case Management desirable. Must be able to work with the Indian Community, and be sensitive to the Indian Culture and its needs.
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