Utilization Management Nurse

We are curing cancer! We treat over 1.5 Million Patients each year!

  • La Mirada, CA
  • $85,000 - $115,000
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A bit about us:

We 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 Details

Responsibilities:
  • 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 development

Requirements:
  • 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 Systems
Easy Apply Now
Easy Apply Now
Job Details
Managed by Jobot Pro
Location
La Mirada, CA
Job Type
Permanent
Compensation
$85,000 - $115,000