LVN Nurse Reviewer - AIM Glendale - 40217 - (US-CA-Glendale - 91226)

Minimum Education: Bachelors
Job Type: Full Time
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American Imaging Management (AIM) is the nation's leading provider of diagnostic imaging management services. Our clinical operations group seeks a experienced nurses to join our collegial team of Nurse Reviewers in AIM's newly-opened Glendale, CA contact center.

LVN Nurse Reviewers are responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. They collaborate with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits.
* Receive preauthorization requests from front-line Referral Specialists through direct call transfer
* Conduct initial medical necessity clinical screening
* Determine if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review
* Conduct initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network
* Verbally notify ordering physician or rendering service provider office of the preauthorization determination decision
* Document the results of the initial clinical review and determination in the precertification computer system.
* Disseminate faxes to providers to request additional clinical information as applicable
* Maintain confidentiality of patient and provider specific information
* Maintain telephone service standards in accordance with pre-established departmental performance metrics

Founded in 1989, AIM is one of the oldest and largest companies in the radiology benefit management industry. A proud member of the WellPoint family of companies, AIM partners with leading health plans and health care providers to promote the most appropriate use of outpatient diagnostic imaging through the application of widely accepted clinical guidelines delivered through responsive, customized solutions, a commitment to clinical excellence, and industry leading, innovative technologies.

Skills:
Graduate of an accredited school of nursingLicensed Vocational Nurse (LVN) with a current, valid unrestricted license in the state of CaliforniaMinimum of three (3) years recent clinical nursing experience in an ambulatory or hospital settingFamiliarity with managed health care programs including HMO, PPO, and POSFamiliarity with Utilization Management Guidelines preferredFamiliarity with ICD-9 and CPT 4 coding preferredPrevious utilization and/or quality management and/or call center experience helpfulCandidates should have good computer skills and solid typing speed and accuracy

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