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UTILIZATION REVIEW & PAYORS SPECIALIST III
Job Field: Legal Jobs
Location: Oakland, CA
Salary: $Not stated
Location: Oakland, CA
Salary: $Not stated
JOB SUMMARY:
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<tr><td valign="top" width="450"><b>Utilization Review & Payors Specialist IIICategory: ProfessionalFacility: Children''s Hospital & Research Center OaklandDepartment: Utilization ManagementSchedule: Per DiemShift: Rotating ShiftsHours: Variable shiftsFTE: 0.00000Job Details: State LicenseLicensed Vocational NurseRegistered Nurse (RN) LicenseJob Summary:The Utilization Review New Payor Specialist III provides clinical that includes admission, concurrent and retrospective review to health care payors and review agencies. As part of an interdisciplinary team provides case management services for complex respiratory patients from ICU, this person also supports ICN and MED/Surg case mangers in procuring ordered equipment assuring a safe and timely discharge of patients. The Utilization Review Nurse Payor Specialist III also ensures that patients hospitalized are reviewed for potential Califomia Children''s Service (CCS) eligibility, and refers as appropriate.Position Requirements:Current California RN License or current LVN license. Experience in all aspects of Utilization Management specific to the function and tasks of Utilization Review, Discharge Planning and Case Management. Concrete knowledge of California Children''''s service Medical Eligibility Criteria. CCR Title 22, CCR Title 10, CHCRO''s Clinical Practice Guidelines, InterQual Pediatric Medical Management Criteria. Working knowledge of Managed Care and the regulations that govern i.e. MRMIB, CCR Title 22 & Title 10. Computer proficiency Microsoft Office.Physical Requirements:Sit: Up to 8 hours/dayStand/Walk: 3-6 hoursBend/Stoop: Up to 3 hoursReach: Up to 3 hoursRep Use of UE/Grasp: Up to 8 hrsLift/Push/Pull: 15 lbsThis job requires the ability to hear alarms clients and/or instruction. The ability to see accurately from 20 inches to 20-ft. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of this position.
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<tr><td valign="top" width="450"><b>Utilization Review & Payors Specialist IIICategory: ProfessionalFacility: Children''s Hospital & Research Center OaklandDepartment: Utilization ManagementSchedule: Per DiemShift: Rotating ShiftsHours: Variable shiftsFTE: 0.00000Job Details: State LicenseLicensed Vocational NurseRegistered Nurse (RN) LicenseJob Summary:The Utilization Review New Payor Specialist III provides clinical that includes admission, concurrent and retrospective review to health care payors and review agencies. As part of an interdisciplinary team provides case management services for complex respiratory patients from ICU, this person also supports ICN and MED/Surg case mangers in procuring ordered equipment assuring a safe and timely discharge of patients. The Utilization Review Nurse Payor Specialist III also ensures that patients hospitalized are reviewed for potential Califomia Children''s Service (CCS) eligibility, and refers as appropriate.Position Requirements:Current California RN License or current LVN license. Experience in all aspects of Utilization Management specific to the function and tasks of Utilization Review, Discharge Planning and Case Management. Concrete knowledge of California Children''''s service Medical Eligibility Criteria. CCR Title 22, CCR Title 10, CHCRO''s Clinical Practice Guidelines, InterQual Pediatric Medical Management Criteria. Working knowledge of Managed Care and the regulations that govern i.e. MRMIB, CCR Title 22 & Title 10. Computer proficiency Microsoft Office.Physical Requirements:Sit: Up to 8 hours/dayStand/Walk: 3-6 hoursBend/Stoop: Up to 3 hoursReach: Up to 3 hoursRep Use of UE/Grasp: Up to 8 hrsLift/Push/Pull: 15 lbsThis job requires the ability to hear alarms clients and/or instruction. The ability to see accurately from 20 inches to 20-ft. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function of this position.
KEY REQUIREMENTS:
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