RN or LVN Utilization Review

Employer
Medical Professionals
Location
Redwood City, CA, US
Salary
Competitve
Posted
Aug 28, 2017
Closes
Oct 01, 2017
Ref
a70d1737
Specialty
LPN / LVN
Contract Type
Permanent
Job Description

We are seeking a RN or LVN to join the Utilization Team Department!

  • Review medical records, benefit, and other guidelines to determine benefit coverage, , scope availability, and level of care considerations.
  • Work closely with Primary Care and Specialist physicians, Medical Director, ancillary providers and case management to coordinate member care.
  • Update and processes member records.
  • Physician and ancillary Providers and Health Plans with issues that require medical interpretation, research or clarification.
  • Clarifies information and answers prior authorization questions from medical offices and providers

  • Performs audit of prior authorization database to monitor timelines set by NCQA.

  • Prepares frequent emergency room usage information for UM management.

Requirements:

  • RN or LVN license in CA
  • BS or BA
  • 3+ years of relevant experience
Company Description

Medical Professionals connects hiring and healthcare! Building careers and companies that last a life time and creating opportunities for all!

We offer nationwide recruiting for nursing, Medical Assistants, central business office, administrative, finance, technology, laboratory and scientific, allied health, healthcare professionals and more.

Your career is our purpose! View more openings on our website! Connect with us today!

https://www.medicalprofessionals.com/career-seekers/

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