Clinical Nurse Reviewer RN/LVN id-11813
As one of the fastest growing Independent PhysicianAssociations in Southern California, our organization offers a fast-paced,exciting, welcoming and supportive work environment. Opportunities abound, andenterprising, capable, focused people prosper with us. We promote teamwork,nurture learning, and encourage advancement for all of our employees. We wantto see you excel, because we believe that your success is our success.
We currently have an opening for Clinical Nurse Reviewer
The Clinical nursereviewer will specifically run analysis on this line of business and reviewwith the Regional Medical Director(s) high cost prior authorization requests aswell as hospital readmissions. Also responsible for the optimization andintegration of these areas: member services, network management, provider andmember relations, marketing, training/development, resource management, as itmay relate to this product line. Working collaboratively with the Regional MedicalDirector to fulfill the business and medical management needs and initiatives.
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Qualifications
1. Minimum of 2 years relevant work experience in a managedcare 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 andPower Point)
6. Must be able to travel within service area and have valid driver's licenseand insurance (preferred)
We offer a full benefits package which includes employer paid medical, pharmacyand 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
