Utilization Review-Case Management Registered Nurse (Full-Time) at Aurora San Diego San Diego, CA

Work as a member of a 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.

Pay Range: $50/hr to $60/hr.

Work Schedule: Monday to Friday, 8:00 a.m. – 4:30 p.m.

Responsibilities

• Admissions: Conduct admission reviews.
• Concurrent/Stay Reviews: Conduct concurrent and extended stay reviews.
• Payment Appeals: Prepare and submit appeals to third party payers.
• Recordkeeping: Maintain appropriate records of the Utilization Review Department.
• Training: Provide staff in-service training and education.
• Maintain confidentiality of patients at all times.
• Cope well with stress and have a strong sense of compassion.
• Show sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds.

Skills

• Proficiency with software and/or equipment (Microsoft Office: Outlook, Word, Excel & 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 and possessing skills to lead, influence, and motivate others.
• Ability to work in a fast-paced, expanding organization.
• 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.

Requirements

• Current California Registered Nurse Licence.
• BLS (Basic Life Support) Certification for Healthcare Providers – American Heart Association.
• 1 year work experience with Utilization Review/Case Management.

Benefits

• 401(k) 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