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Overview
We are seeking a dedicated Utilization Review Nurse to join our team. The ideal candidate is primarily responsible for submitting and overseeing the insurance approval, denials and appeals process for CHP. The responsibility includes the daily/monthly insurance reviews, reconciliations and analysis, working with insurance carriers through appeals, processing in compliance with state and federal guidelines.
Responsibilities
- Conduct utilization review to assess the necessity and efficiency of medical services
- Evaluate medical records for completeness and accuracy
- Collaborate with healthcare providers to optimize patient care plans
- Ensure compliance with regulatory requirements and standards
- Identify opportunities for clinical documentation improvement
- Utilize anatomy knowledge to assess medical necessity of procedures
- Perform case management duties to facilitate patient transitions
Experience
- Required skills: Bachelor's Degree in related field or equivalent required.
- Nice-to-have skills: Clinical documentation improvement, Anatomy knowledge, Case management.
- Previous experience in utilization review or related field preferred
- Strong analytical and critical thinking skills
- Excellent communication and interpersonal abilities
Join our team as a Utilization Review Nurse to make a meaningful impact on patient outcomes and healthcare quality.
Job Type: Full-time
Pay: $33.85 - $36.92 per hour
Expected hours: 40 per week
Benefits:
Medical Specialty:
Schedule:
Experience:
License/Certification:
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Work Location: In person
Full Time
$71k-91k (estimate)
08/22/2024
12/18/2024
The job skills required for Utilization Review Nurse include Patient Care, Critical Thinking, etc. Having related job skills and expertise will give you an advantage when applying to be an Utilization Review Nurse. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Utilization Review Nurse. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Utilization Review Nurse positions, which can be used as a reference in future career path planning. As an Utilization Review Nurse, it can be promoted into senior positions as a Clinical Outcomes Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Utilization Review Nurse. You can explore the career advancement for an Utilization Review Nurse below and select your interested title to get hiring information.