# Utilization Review-Case Management Registered Nurse (Full-Time)

**Company:** [Aurora San Diego](http://jobs.workable.com/companies/7dSFrr13xiK5dZkyM5Mk8c.md)
**Location:** San Diego, United States
**Workplace:** on site
**Department:** Utilization Review

[Apply for this job](http://jobs.workable.com/view/e448e2ee-c1d0-4c3a-acad-eac017e46e72)

## Description

Work as member of multi-disciplinary treatment team reviewing patient care and treatment options for both inpatient and outpatient services. Proactively monitor and optimize reimbursement for external reviewers/third party payers.

\*Pay Range: $50/hr. to $60/hr.

Work Schedule: Monday to Friday from 8:00 a.m. to 4:30 p.m.

Responsibilities:

-   Admissions: Conduct admission reviews
-   Concurrent/Stay Reviews: Conduct concurrent and extended stay reviews
-   Payment Appeals: Prepare and submit appeals to third party payers
-   Recordkeeping: Maintains appropriate records of the Utilization Review Department
-   Training: Provide staff in-service training and education
-   Maintains confidentiality of patients at all times
-   Ability to cope well with stress and have a strong sense of compassion
-   Sensitivity to and willingness to interact with persons of various social, cultural, economic and educational backgrounds
-   Proficiency with software and/or equipment (Microsoft Office applications including Outlook, Word, Excel and PowerPoint)
-   Strong organizational skills with ability to prioritize projects, work relatively independently, manage multiple tasks, and meet deadlines
-   Strong written and verbal communication skills
-   Strong interpersonal skills. Ability to work with people with a variety of background and educational levels
-   Ability to work independently and as part of a team
-   Good judgment, problem solving and decision-making skills
-   Demonstrated commitment to working collaboratively as well as possessing the skills to lead, influence, and motivate others
-   Ability to work in a fast-paced, expanding organization

Skills:

-   Demonstrated knowledge of health care service delivery systems and third party reimbursement
-   Two or more years’ experience working in managed care environment
-   Ability to apply and interpret admission and continued stay criteria
-   Strong understanding of admission and discharge function
-   Familiarity with medical terminology, diagnostic terms and treatment modalities
-   Knowledge of medical record keeping requirements
-   Ability to comprehend psychiatric evaluations, consults, and lab results

## Requirements

-   Current California Registered Nurse License
-   BLS (Basic Life Support ) Certification for Healthcare Providers - American Heart Association
-   1 year work experience with Utilization Review-Case Management

## Benefits

-   401K Retirement Plan
-   Health Insurance
-   Vision Insurance
-   Dental Insurance
-   Pet Insurance
-   Healthcare Spending Account & Dependent Care Spending Account
-   Life Insurance (Supplemental Life, Term, and Universal plans are also available.)
-   PTO Plan with Holiday Premium Pay
-   PTO Cash Out option
-   Sick Pay
-   Short and Long-Term Disability (with additional buy-in opportunities)
-   Tuition Reimbursement
-   Employee Assistance Program
-   ID Theft Protection