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Utilization Management Nurse

Company: Jobot
Location: La Mirada
Posted on: August 7, 2022

Job Description:

We are curing cancer! We treat over 1.5 Million Patients each year!This Jobot Job is hosted by: Kat LawrenceAre you a fit? Easy Apply now by clicking the "Apply Now" button and sending us your resume.Salary: $85,000 - $115,000 per yearA bit about us:We offer cutting-edge treatment solutions in the community setting, focusing on underserved populations. We serve close to 2 million patients each year in over 50 clinics across the country, and we are changing Healthcare for the better!Why join us?If you'd like to join a team that believes everyone should have access to quality healthcare, come join our org delivering highly specialized, value-based care. We offer competitive comp packages and Medical/Dental/Vision/401k match and more! Hybrid schedule after training is complete!!Job DetailsResponsibilities:

  • Review authorizations from the chemo authorization team and/or escalated requests for clinical topics, and provide guidance
  • Ensure appropriate matches between authorization regimen requests, diagnoses on record, and submitted documentation to improve chances of first-time approvals and successful reimbursement
  • Interface with Oncologists to answer questions related to chemo authorization, address adjustments to regimen orders per protocols, and implement UM Medical Director guidance
  • Participate in processing physician orders and preparation of prior authorizations for submission when needed
  • Participate in the improvement of the organizations authorization processes and support developmentRequirements:
    • Graduation from an accredited LVN, RN, and/or NP program
    • Active license
    • 2+ years experience in medical oncology clinical or administrative environment
    • Experience with Utilization Management, Prior Authorizations, and/or Managed Care Operations within a health insurer, medical group, hospital, healthcare provider or payer environment
    • Proficiency with Microsoft Office Suite, EMRs, Practice Management SystemsInterested in hearing more? Easy Apply now by clicking the "Apply Now" button.

Keywords: Jobot, La Mirada , Utilization Management Nurse, Healthcare , La Mirada, California

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