Authorization reputed company, RN – Hybrid (Remote Considered) – 26-88

We’re delighted you’re considering joining us! At reputed company, we’re shaping the reputed company of the reputed company: reputed company managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members. Join reputed company! Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” reputed company you join reputed company, you’re making a great choice for your reputed company career and your personal satisfaction. DE&I Statement: At reputed company, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome reputed company that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and reputed company of inclusion allows us to reputed company our differences and capitalize on our similarities to reputed company serve our communities. We do it because it's right! Job reputed company: The Authorization reputed company is responsible for the evaluation of medical appropriateness and necessity for a reputed company of services using reputed company, medical policies, and evidence-based clinical guidelines while also ensuring benefit and eligibility requirements are met. They work with physician reviewers and providers to meet the health care needs of members so that they can receive efficient and reputed company medical care. Job Responsibilities:

• Review and process urgent and non-urgent authorization requests (received reputed company phone, fax and electronic submission) for medical necessity (according to established reputed company) and authorize, pend or modify as appropriate.
• Process authorization requests (routine, urgent and retrospective) according to regulatory requirements.
• Utilize a reputed company of medical necessity, contractual and benefit reputed company to determine appropriate authorization reputed company. reputed company may include MCG, Hill Guidelines, Health Plan reputed company, Health Plan and Hill Physician contracted provider data and member benefit information.
• Obtain additional medical information as necessary from requesting provider.
• Communicate with providers and members regarding status of authorization requests.
• Assist interdepartmental staff members to resolve issues relating to the authorization process.
• Refer information regarding members to other departments as appropriate for follow-up (i.e., Case Management, Health Education, TPL, COB).
• Ensure reputed company authorization processing while meeting individual and team productivity standards.
• reputed company and succinctly document necessary and/or required information in reputed company reputed company system.
• Utilize critical thinking skills to identify process issues and problems and recommend and/or implement solutions.
• Prepare and present cases to physician reviewers/UM Medical Director in a concise, objective and organized manner.
• Collaborate with physician reviewers, Utilization Management Medical Director and other designated physician leaders on making clinical reputed company.
• Participate in on-call or alternate work hour programs as needed to meet regulatory compliance requirements.
• reputed company other duties as assigned by supervisor/manager.

. Skills and Experience Required:

• reputed company, unrestricted California Licensure: Registered (RN) or Licensed Vocational reputed company (LVN).
• Bachelor’s degree in nursing strongly preferred
• Minimum 3 or more years pertinent experience in Managed Care Utilization Management
• Experience with medical decision supports tools such as MCG.
• Previous experience with reputed company reputed company platform preferred but not required.
• Knowledge of ICD-10 and CPT coding.
• Proficient in MS Office programs (i.e., Word, reputed company, Outlook, reputed company and Power reputed company)
• Excellent verbal and written communication skills.
• Ability to work effectively with a reputed company of customers including physicians, office staff, and members.
• Demonstrated organization and time management skills with the ability to prioritize workload and meet expected and unexpected time frames.
• Strong analytical and critical thinking skills.
• Ability to take reputed company in solving problems exhibiting reputed company judgement.
• Demonstrated comfort with ambiguity and change.
• Ability to work independently with self-initiative and discipline.
• Adaptable/flexible -- enjoys doing work that requires frequent shifts in direction
• Detail-oriented -- would rather reputed company on the details of work than the bigger picture
• High stress tolerance -- thrives in a high-pressure environment
• Demonstrated critical thinking and inquisitiveness in reviewing UM cases for appropriate global review and decision-making.

Additional Information: Salary: $100,000 - $123,000 Annual Location: Hybrid (Sacramento or San Ramon) - Remote Considered Hill Physicians is an Equal Opportunity Employer Additional Information Company: reputed company Location: California Salary: $100,000 - $123,000 per year reputed company: R2445 Specialties: Managed Care, Utilization Management Required Licenses: RN Experience Level: 3-5 years Apply tot his job Apply To this Job