Utilization Review RN

1 month ago


Pasadena, United States Las Encinas Hospital Full time
Job DescriptionJob Description

 

  • Proven experience in conceptualizing a case, and creating a clinical impression to present to all managed care representatives.
  • Establish and maintain positive effective communication with insurance case
  • Read and understand patients case notes and be able to assign appropriate diagnosis codes.
  • Call in intakes and/or peer to peers, and get the patients appropriate level of care authorized by the case managers.
  • Obtain and communicate LOC and authorizations and properly enter into the system.
  • Detailed system documentation of accounts.
  • Communicating with other departments to obtain or provide needed information on an account.
  • Special Projects as needed.

Required Education and Experience:

  • Previous experience working in a psychiatric or chemical dependency setting, with two years of utilization review experience preferred.
  • Registered Nurse


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