Utilization Review-Case Management Registered Nurse (Full-Time)
Work as member of multi-disciplinary treatment team reviewing patient care and treatment options for both inpatient and outpatient services. Proactively monitor and optimize reimbursement for external reviewers/third party payers.
*Pay Range: $50/hr. to $60/hr.
Work Schedule: Monday to Friday from 8:00 a.m. to 4:30 p.m.
Responsibilities:
- Admissions: Conduct admission reviews
- Concurrent/Stay Reviews: Conduct concurrent and extended stay reviews
- Payment Appeals: Prepare and submit appeals to third party payers
- Recordkeeping: Maintains appropriate records of the Utilization Review Department
- Training: Provide staff in-service training and education
- Maintains confidentiality of patients at all times
- Ability to cope well with stress and have a strong sense of compassion
- Sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds
- Proficiency with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint)
- Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines
- Strong written and verbal communication skills
- Strong interpersonal skills. Ability to work with people with a variety of background and educational levels
- Ability to work independently and as part of a team
- Good judgment, problem solving and decision-making skills
- Demonstrated commitment to working collaboratively as well as possessing the skills to lead, influence, and motivate others
- Ability to work in a fast-paced, expanding organization
Skills:
- Demonstrated knowledge of health care service delivery systems and third party reimbursement
- Two or more years’ experience working in managed care environment
- Ability to apply and interpret admission and continued stay criteria
- Strong understanding of admission and discharge function
- Familiarity with medical terminology, diagnostic terms and treatment modalities
- Knowledge of medical record keeping requirements
- Ability to comprehend psychiatric evaluations, consults, and lab results
Requirements
- Current California Registered Nurse License
- BLS (Basic Life Support ) Certification for Healthcare Providers - American Heart Association
- 1 year work experience with Utilization Review-Case Management
Benefits
- 401K Retirement Plan
- Health Insurance
- Vision Insurance
- Dental Insurance
- Pet Insurance
- Healthcare Spending Account & Dependent Care Spending Account
- Life Insurance (Supplemental Life, Term, and Universal plans are also available.)
- PTO Plan with Holiday Premium Pay
- PTO Cash Out option
- Sick Pay
- Short and Long-Term Disability (with additional buy-in opportunities)
- Tuition Reimbursement
- Employee Assistance Program
- ID Theft Protection