| Job # |
 |
Job Title |
|
Department |
| 101064 |
|
Medical Referral Nurse |
|
Referral Services |
Job Description
To provide comprehensive Utilization Management services working in conjunction with the healthcare team across all lines of business to ensure members access to medically necessary, quality health care services provided at the appropriate level of care in a timely manner incorporating cost containment strategies. To comply with NCQA, health plan and Brown and Toland Physicians (BTP) guidelines and perform utilization review activities to determine medical necessity using nationally recognized guidelines.
Skills Required
- Registered Nurse with current, unrestricted California RN license; CCM, CDMS, CRC, CRRN, CHON, CPUR preferred.
- Minimum three (3) to five (5) years acute care experience nursing or outpatient clinic.
- Familiar with ICD 9, CPT and HCPCS codes a plus.
- Excellent interpersonal, organizational, verbal, and written communication skills.
- Ability to set priorities and be highly productive, work well under pressure and independently along wit being a team member.
- Computer skills essential, internet searches, MS Office, IDX, Interqual, typing about 50wpm.
- Strong negotiation skills.
Apply at careers@btmg.com |