Utilization Management Nurse Reviewer
- Full-time
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About The Position
HealthSmart Management Services Organization, Inc. is looking for a full-time qualified UM Nurse Reviewer who will be responsible for reviewing and processing Authorization requests of medical services from health professions, clinical facilities and ancillary providers. Qualified candidate will coordinate with Providers and their office designees as a resource for their various inquiries and needs.
Job Description
Utilization Management Nurse Reviewer
About The Position
HealthSmart Management Services Organization, Inc. is looking for a full-time qualified UM Nurse Reviewer who will be responsible for reviewing and processing Authorization requests of medical services from health professions, clinical facilities and ancillary providers. Qualified candidate will coordinate with Providers and their office designees as a resource for their various inquiries and needs.
Experience & Education Requirements :
- High School Graduate or equivalent required.
- Current unrestricted RN or LVN License to practice in the State of California.
- Minimum of three (3) years current clinical experience preferred.
- IPA and Managed care experience preferred.
- Knowledge of medical criteria for Apollo, MCG and Medicare / Medi-Cal guidelines.
- Excellent telephone skills required.
- Computer experience desirable.
- Excellent interpersonal skills.
- ICD 10- CM and CPT / HCPCS Medical Coding
- Strong problem solving, organizational skills and time management skills with the ability to work in a fast-paced environment.
ACCOUNTABILITY / DUTIES / RESPONSIBILITIES :
WORK ENVIRONMENT, PHYSICAL DEMANDS AND MENTAL DEMANDS :
HealthSmart Management Service Organization, Inc provides a full suite of benefits :
Company Description
HealthSmart MSO, Inc. (HSMSO) is a management service organization serving the needs of providers in a managed care setting. Our Vision is to motivate, facilitate, and create opportunities for our client's and team. HealthSmart MSO's goal is to ensure its Managed IPA's, Medical Groups, Hospitals and Physician Practices have a coordinated cost effective delivery system where quality services to members and physicians are achieved. Together, members and providers work toward a common goal of wellness and preventive medicine. As needs arise, physicians and their members feel comfortable knowing that they will receive care from the most dedicated and friendly managed care team.
HealthSmart MSO, Inc. (HSMSO) is a management service organization serving the needs of providers in a managed care setting. Our Vision is to motivate, facilitate, and create opportunities for our client's and team. HealthSmart MSO's goal is to ensure its Managed IPA's, Medical Groups, Hospitals and Physician Practices have a coordinated cost effective delivery system where quality services to members and physicians are achieved. Together, members and providers work toward a common goal of wellness and preventive medicine. As needs arise, physicians and their members feel comfortable knowing that they will receive care from the most dedicated and friendly managed care team.
Seniority level
Seniority level
Mid-Senior level
Employment type
Employment type
Full-time
Job function
Job function
Health Care Provider
Industries
Insurance and Employee Benefit Funds
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