Clinical Nurse Reviewer RN/LVN

Clinical Nurse Reviewer

As one of the fastest growing Independent Physician Associations in Southern California, our organization offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

We currently have an opening for Clinical Nurse Reviewer. The Clinical nurse reviewer will specifically run analysis on this line of business and review with the Regional Medical Director(s) high cost prior authorization requests as well as hospital readmissions. Also responsible for the optimization and integration of these areas: member services, network management, provider and member relations, marketing, training/development, resource management, as it may relate to this product line. Working collaboratively with the Regional Medical Director to fulfill the business and medical management needs and initiatives.

Qualifications

1. Minimum of 2 years relevant work experience in a managed care setting, health plan or large medical group administration. 2. Knowledge of the prior authorization process. 3. Knowledge of contracting principles/tools. (preferred) 4. Excellent verbal and written communication skills. 5. Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point) 6. Must be able to travel within service area and have valid driver's license and insurance (preferred) We offer a full benefits package which includes employer paid medical, pharmacy and dental benefits. We offer a generous PTO package, 401k Retirement Savings, Life Insurance, Flexible Spending Account (FSA), Tuition Reimbursement & Licensed Renewal Fees for our clinical staff.

City: Glendale