RN Utilization Review & Precertification Specialist

Kaiser Permanente; Atlanta (GA); On-site; USD 56,000 - 72,000; Full time

Job summary

Kaiser Permanente in Atlanta, GA is seeking a Nurse who will perform precertification and medical necessity reviews for referrals, outpatient procedures, and admissions. You will use criteria and guidelines, communicate with care coordinators, and participate in quality improvement efforts.

You will collaborate with physicians and various departments to ensure appropriate level of care, timely reviews, and accurate documentation in medical records, while educating members as needed.

Qualifications

• Minimum three (3) years of RN clinical nursing.
• Experience with Managed Health Care Delivery Systems.
• Experience in ICD9/CPT4 coding.

Responsibilities

• Perform precertification and referral reviews within required timeframes.
• Coordinate with care teams to ensure appropriate level of care.
• Provide education to patients and families as needed.

Skills

RN clinical nursing

Utilization management

Discharge planning

Quality improvement

Education

High school diploma or GED

Bachelor's degree in nursing

Tools

ICD9/CPT4 coding

Job description

Kaiser Permanente in Atlanta, GA is seeking a Nurse who will perform precertification and medical necessity reviews for referrals, outpatient procedures, and admissions. You will use criteria and guidelines, communicate with care coordinators, and participate in quality improvement efforts.

You will collaborate with physicians and various departments to ensure appropriate level of care, timely reviews, and accurate documentation in medical records, while educating members as needed.