Pediatric Utilization Review Specialist

CHOC Children's; Orange (CA); On-site; USD 40,000 - 68,000; Full time

Job summary

CHOC Children's in Orange, California, is seeking a dedicated Utilization Review Representative to manage utilization review for inpatient and outpatient statuses and to coordinate with payors for treatments, services, and supplies in partnership with RN Care Managers.

You will assist in RN Care Manager caseload, perform data collection, insurance verification, financial counseling and customer service, and ensure that all processed work is accurate and complete while upholding CHOC's commitment

Qualifications

• Licensed Vocational Nurse (CA) with current license.
• Graduation from an accredited nursing program; BSN preferred.
• Experience with utilization review and payor communications helpful.

Responsibilities

• Review inpatient and outpatient statuses for utilization.
• Process internal and external authorization requests with payors.
• Assist RN Care Managers with caseload and data collection.
• Ensure accuracy and completeness of all processing and documentation.

Skills

Interpersonal communication

Conflict resolution

Negotiation skills

Multi-tasking

Education

Licensed Vocational Nurse (CA)

Bachelor of Science in Nursing

Tools

MS Excel

MS Office

Job description

CHOC Children's in Orange, California, is seeking a dedicated Utilization Review Representative to manage utilization review for inpatient and outpatient statuses and to coordinate with payors for treatments, services, and supplies in partnership with RN Care Managers.

You will assist in RN Care Manager caseload, perform data collection, insurance verification, financial counseling and customer service, and ensure that all processed work is accurate and complete while upholding CHOC's commitment