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Registered Nurse / Utilization Review Nurse

Spokane, WA | Hiring Audition

Job ID: 00003PBV Job Category: HEALTHCARE - Clinical. Certified Pay Rate: 45.00
Are you a Registered Nurse looking to move into the appeals field of healthcare? If you are proficient in Microsoft Office products and you thrive in proactive environments, this opportunity will be PERFECT for you!

Our client, a premier healthcare organization, is looking for a Utilization Review Nurse in their Appeals Department! The right candidate will act as a liaison between the doctors and the appeals team. The team consists of 12 individuals and you will be the trainer in this position to find best practices and provide strategic thinking for new processes.

Job Responsibilities:
* Review coverage requests using established timelines
* Summarize findings and facilitate appropriate authorizations or payments
* Prepare information for review by the physician reviewer
* Determine if new services are experimental or investigational and whether the service requires a new medical technology assessment.
* Assist appeal coordinators and specialists with interpreting clinical notes, identifying missing clinical information and educating staff on appropriate documentation/summaries required for physician review
* Work with physicians, staff and management to create standards and address process improvements
* Readily answer questions from appeals staff and help to differentiate medical necessity issues from procedural or regulatory items

Job Requirements:
*Minimum of 2 years experience in clinical nursing
* Current Washington State RN License
* Proficiency in Microsoft Word and Outlook
* Extremely detail oriented
* 2 years of experience with medical code review is preferred but not required
* 2 years of experience in utilization/quality management preferred
* Our client has a drug free workplace, and abides by federal law identifying marijuana as an illegal substance. All candidates must pass a drug test and background check prior to being hired on for an assignment.

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