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 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 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 #J-18808-Ljbffr