Job description

Overview
We are seeking a dedicated Utilization Review Nurse to join our team. The ideal candidate is primarily responsible for submitting and overseeing the insurance approval, denials and appeals process for CHP. The responsibility includes the daily/monthly insurance reviews, reconciliations and analysis, working with insurance carriers through appeals, processing in compliance with state and federal guidelines.

Responsibilities
- Conduct utilization review to assess the necessity and efficiency of medical services
- Evaluate medical records for completeness and accuracy
- Collaborate with healthcare providers to optimize patient care plans
- Ensure compliance with regulatory requirements and standards
- Identify opportunities for clinical documentation improvement
- Utilize anatomy knowledge to assess medical necessity of procedures
- Perform case management duties to facilitate patient transitions

Experience
- Required skills: Bachelor's Degree in related field or equivalent required.
- Nice-to-have skills: Clinical documentation improvement, Anatomy knowledge, Case management.
- Previous experience in utilization review or related field preferred
- Strong analytical and critical thinking skills
- Excellent communication and interpersonal abilities

Join our team as a Utilization Review Nurse to make a meaningful impact on patient outcomes and healthcare quality.

Job Type: Full-time

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Free parking
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance