RN-Medical Review and Management
Advanced Medical Reviews, one of the leading Independent Review Organizations in the nation, helps hospitals, medical insurance carriers, and state health agencies resolve coverage disputes and evaluate quality of care. Our experienced medical network, comprised of actively practicing board-certified physicians and licensed healthcare professionals, provides comprehensive medical opinions all throughout the nation.
We are currently seeking a full-time Registered Nurse to work collaboratively with physicians as a medical review, quality assurance professional. This individual should be self-directed, assertive, and creative in problem solving.
In this position, you will apply your clinical skills and expertise in conjunction with established medical criteria to ensure independent reviews are accurate and complete. You will serve as a subject matter expert on complex medical management issues. This position provides quality assurance for independent medical reviews and utilization review services according to current URAC standards. And it allows you to evaluate and analyze available literature on new and existing technologies to determine safety and effectiveness as it relates to the quality of independent reviews.
Required Qualifications:
• Current and unrestricted RN license in any of the 50 states
• Minimum 3 years of clinical experience in an acute care setting
• Minimum 2 years experience in utilization review, utilization management, or quality improvement processes
• Demonstrated ability to utilize and apply the general and specialized principles, techniques and methods of utilization review and management
• Excellent verbal and written communication, analytical and interpersonal skills
• Excellent problem identification/problem solving and follow through skills
• Ability to organize and prioritize multiple assignments within workload
• Ability to both function independently and take independent action within the scope of the job responsibilities, and work collaboratively with interdisciplinary teams
• Solid computer skills with word processing, spreadsheets, etc.
Preferred Qualifications:
• Knowledge of industry-recognized national guidelines
• Experience in working with established guideline criteria to decide issues of medical necessity, experimental/investigational, utilization review, quality of care/peer review, disability, level or care/length of stay, billing/coding
Start Date: ASAP
Location: West Los Angeles Office
Hours: Full time
Compensation: Competitive - includes medical, dental, vision, paid time off, and 401K
Send resume: Please include your salary expectations and complete the application online at
https://home.eease.adp.com/recruit/?id=915071
Please do not reply to this ad via e-mail, simply go to the website to apply.
Contact:
Sarah E. Spivey
HR Coordinator
10780 Santa Monica Blvd, #333
Los Angeles, CA 90025
sspivey@admere.com
310-575-0900 x508