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

Aurora San Diego•San Diego, CA

14d•$50 - $60

About The Position

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.

Requirements

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
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

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

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