Utilization Review-Case Management Registered Nurse (Full-Time)

Aurora San Diego • San Diego, CA

5d • Remote

About The Position

Work as a member of a 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.

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
• 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
• 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

Responsibilities

• Conduct admission reviews
• Conduct concurrent and extended stay reviews
• Prepare and submit appeals to third party payers
• Maintains appropriate records of the Utilization Review Department
• Provide staff in-service training and education
• Maintains confidentiality of patients at all times

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level