As one of the fastest growing Independent Physician Associations in Southern California, our organization offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
We currently have an opening for Clinical Nurse Reviewer
The Clinical nurse
reviewer will specifically run analysis on this line of business and review
with the Regional Medical Director(s) high cost prior authorization requests as
well as hospital readmissions. Also responsible for the optimization and
integration of these areas: member services, network management, provider and
member relations, marketing, training/development, resource management, as it
may relate to this product line. Working collaboratively with the Regional Medical
Director to fulfill the business and medical management needs and initiatives.
Qualifications
1. Minimum of 2 years relevant work experience in a managed
care 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 and
Power Point)
6. Must be able to travel within service area and have valid driver’s license
and insurance (preferred)
We offer a full benefits package which includes employer paid medical, pharmacy
and 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
Skills Required
- Minimum of 2 years relevant work experience in a managed care setting, health plan or large medical group administration.
- Knowledge of the prior authorization process.
- Knowledge of contracting principles/tools.
- Excellent verbal and written communication skills.
- Proficient in MS Office programs (Word, Excel, Outlook, Access, Power Point).
- Must be able to travel within service area and have valid driver's license and insurance.
What We Do
HealthCare Pros is a staffing agency that places nurses and other healthcare professionals in travel, per diem, and local positions, acting as a partner in their careers.
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