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Position Summary:
The role of the Nurse Reviewer is to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization specialty referral requests as well as acute inpatient admission. The Nurse Reviewer will review for appropriate care and setting, and following guidelines/policies, will approve services when indicated. If not indicated, Nurse Reviewer will forward requests to the appropriate physician or medical director with recommendations for other determinations, ensuring that the member is receiving the appropriate quality care in a preferred setting, while making sure regulatory guidelines are followed.
Work in collaboration with the Regional Medical Director to thoroughly review member referral history and anticipated needs in an effort to avoid admission. Responsible for identifying possible TOC cases for new members with high cost diagnosis. The Nurse Reviewer will be responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode as well as prior authorizations (particularly those with facility components). Identifying the appropriate facilities in order to provide the highest level of care, in the most efficient manner, while utilizing only the resources necessary for that episode of care.
Essential Duties and Responsibilities include the following:
Requirements:
The pay range for this position at commencement of employment is expected to be between $37.50 - $40 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, 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.
Full Time Position Benefits:
The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.
Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.
Health and Wellness:
Savings and Retirement:
Other Benefits:
Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.
Job Type: Full-time
Pay: $37.50 - $40.00 per hour
Benefits:
Standard shift:
Weekly schedule:
Work Location: In person
Full Time
$77k-94k (estimate)
04/27/2023
07/13/2024
fccbwd.org
San Bernardino, CA
<25
The job skills required for Prior Authorization Nurse include Teamwork, Initiative, Health Insurance, Life Insurance, Communicates Effectively, Dedication, etc. Having related job skills and expertise will give you an advantage when applying to be a Prior Authorization Nurse. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Prior Authorization Nurse. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Prior Authorization Nurse positions, which can be used as a reference in future career path planning. As a Prior Authorization Nurse, it can be promoted into senior positions as a Head Nurse - CCU that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Prior Authorization Nurse. You can explore the career advancement for a Prior Authorization Nurse below and select your interested title to get hiring information.