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Utilization Management Nurse


This is a Contract position in Anaheim, CA posted July 15, 2022.

We are curing cancer! We treat over 1.5 Million Patients each year!This Jobot Job is hosted by Kat LawrenceAre you a fit? Easy Apply now by clicking the “Apply” button and sending us your resume.Salary $85,000 – $115,000 per yearA Bit About UsWe offer cutting-edge treatment solutions in the community setting, focusing on underserved populations. We serve close to 2 million patients each year in over 50 clinics across the country, and we are changing Healthcare for the better!Why join us?If you’d like to join a team that believes everyone should have access to quality healthcare, come join our org delivering highly specialized, value-based care.We offer competitive comp packages and Medical/Dental/Vision/401k match and more!Hybrid schedule after training is complete!!Job DetailsResponsibilities Review authorizations from the chemo authorization team and/or escalated requests for clinical topics, and provide guidance Ensure appropriate matches between authorization regimen requests, diagnoses on record, and submitted documentation to improve chances of first-time approvals and successful reimbursement Interface with Oncologists to answer questions related to chemo authorization, address adjustments to regimen orders per protocols, and implement UM Medical Director guidance Participate in processing physician orders and preparation of prior authorizations for submission when needed Participate in the improvement of the organizations authorization processes and support developmentRequirements Graduation from an accredited LVN, RN, and/or NP program Active license 2+ years experience in medical oncology clinical or administrative environment Experience with Utilization Management, Prior Authorizations, and/or Managed Care Operations within a health insurer, medical group, hospital, healthcare provider or payer environment Proficiency with Microsoft Office Suite, EMRs, Practice Management SystemsInterested in hearing more? Easy Apply now by clicking the “Apply” button.