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  • Sacramento, CA

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Senior Program Review Associate - RN req'd (REMOTE)

IPRO • Sacramento, CA

Posted 1 month ago

Job Snapshot

Full-Time
Experience - 3 years
Not for Profit - Charitable
Health Care

Job Competition

5

Applicants

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Job Description

In this Home Base Senior Program Review Associate position, you will be responsible for the review for external appeals review for private sector clients.  Duties will included but are not limited to: assisting with the development of new review tools as products are developed; screening and write-ups of external appeal review cases; following-up with patients, insurers and providers relative to the external appeal process; preparation of final report determinations for external appeals and tracking of cases to ensure timely response.

QUALIFICATIONS:

 

·         Strong communication skill- must have outstanding written and verbal skills.

·         Strong interpersonal skills with the ability to effectively interact with physicians, senior medical and administrative personnel.

·         Ability to work independently with minimal supervision.

·         Ability to meet short turnaround deadlines for deliverables.

·         Ability to provide rotating pager coverage for external appeals 24 hours/7 days per week.

·         Ability to travel as needed. 

 

 EDUCATION & EXPERIENCE:

 

·         A CA licensed RN, required.

·         A graduate of an approved registered, professional nurses’ training program, required.

·         A Bachelor’s degree in Nursing, preferred.

·         Three (3) years of experience in utilization review, independent review or case management and/or a minimum of four (4) years of experience in an acute care facility preferably in medicine/surgery or special care units.

 

IPRO offers a comprehensive benefits package.

 

IPRO is an Affirmative Action/Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

 

Job Requirements

See above.

Job ID: 19020
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