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Utilization Review Case Management Outpatient Nurse or Clinici Location: US-CA-San Diego Email this job to a friend
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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. *Schedule: Monday - Friday from 8:00 a.m. to 4:30 p.m. *Pay Range: $32/hr. to $60/hr. Essential functions: - 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
Skills and Abilities: - 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
Requirements - Current license as RN, LVN/LPT, LCSW
- Preferred; Masters degree in Social Work, Behavioral Science, or related field
- Current CPR certification
- NCI (or equivalent) preferred but not required
Covid-19 Precautions: Knowledge and Experience: - 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
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
- Employee Discount Opportunities
Aurora San Diego
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