Utilization Review Nurse

Identity MSO - San Luis Obispo, CA (30+ days ago)


Essential Job Responsibilities:

  • Reviews designated request for referral authorizations either proactively, concurrently or retroactively. Gathering all information needed in order to make a determination and/or coordinate with Medical Director as needed.
  • Ensure compliance with turnaround times and accuracy standards are met.
  • Ensure contracted providers are in place when authorizing. If not, responsible to coordinate with contracting to obtain appropriate contracts as deemed appropriate.
  • Identify cases that require additional case management and works with appropriate departments and internal staff to coordinate patient care.
  • Promotes quality, cost effective medical care through strict adherence to all utilization management policies and procedures.
  • Basic computer knowledge

Qualifications:

Minimum of 3 years’ recent clinical experience. Ability to prioritize and organize work area despite multi-faceted task directions and interruptions. Experience and understanding of confidential information. Strong written and verbal communication skills.

Education:

  • An active and unrestricted Nursing license
  • Basic computer knowledge

Job Type: Full-time

License:

  • Registered Nurse (RN)