JOB DESCRIPTION

UTILIZATION REVIEW NURSE

JOIN OUR CLINICAL TEAM

  • Are you seeking career growth that allows you to advocate for healthcare needs in a new and different way?
  • Are you looking for a position that doesn’t require shift work, nights, or regularly scheduled weekends/holidays?
  • Does the potential for working from home intrigue you?

If you answered yes to any of these questions, this Utilization Review Nurse position might be the change you’re seeking.

AllMed Healthcare Management is currently seeking experienced Prior Authorization/Appeals Utilization Review Nurses to join our clinical operations team, working onsite in our beautiful office in downtown Portland, Oregon, or remote from home.

JOB DESCRIPTION

In this role, you will work closely with our medical directors, national peer physician specialists, and clients to provide written medical chart reviews and determinations for prior authorizations and appeals of medical treatments and procedures in nearly all specialties and sub-specialties of medicine.

The Utilization Review Nurse role includes:

  • Performing prior authorization reviews/approvals against health plan policies and clinical review criteria
  • Reviewing medical records and preparing case summaries for physician review of prior authorizations and appeals
  • Ensuring the accuracy of determinations by validating information in the medical record against health plan policies and clinical review criteria
  • Ensuring the quality of final written reviews by close attention to grammar, punctuation, spelling, formatting, and accuracy
  • Meeting quality and productivity standards
  • Working to continuously improve the quality and efficiency of our operations through individual and team projects, participation in continuous improvement events and ongoing learning

REQUIRED SKILLS

  • Current unrestricted Registered Nurse (RN) license
  • Minimum one-year clinical nursing experience; med-surg or critical care experience preferred
  • Ability to type a minimum of 35 words per minute
  • Excellent writing and documentation skills and customer service
  • Computer literacy with demonstrated proficiency in Microsoft Office, email, database, and contact management software, and browser-based workflow applications
  • Exhibit a high degree of professionalism in written and verbal communications
  • Attention to detail; critical eye to catch mistakes and errors

PREFERRED EXPERIENCE & SKILLS

  • Experience in a fast-paced, production-oriented setting
  • Demonstrated experience in utilization management, case review and/or medical necessity review/appeals in a payer or provider setting
  • Bachelor of Nursing or degree in an equivalent field of study

ABOUT ALLMED HEALTHCARE MANAGEMENT

AllMed provides clinical decision making and utilization management solutions to leading payer and provider organizations. We work closely with clients toward a shared vision of healthcare that delivers the highest quality, values patient experience, and ensures both appropriate care and utilization of health-related services.   AllMed is mission-driven to improve the quality and integrity of healthcare and is a recognized leader in this dynamic market.

“At AllMed, you are more than just an employee; you are part of a family. While many employers say this, I know with certainty, even during difficult times, that AllMed has my back. The transparency and openness from our leadership team make the employees feel empowered, trusted, and even more excited to celebrate the growth and success of the company. We have an amazing bunch of people with amazing skills. There is always something new to learn.”

Jennifer L. Crowley, RN MSN/MHA Clinical Quality and Training Lead

“At AllMed Healthcare, we’ve got plenty of perks, a strong commitment to our community, and a caring and compassionate culture. When you add it all up, it’s a GREAT place to work. If you are passionate about helping patients, join our team at AllMed!”

Korinne M. Cline, BSN RN Clinical Quality and Training Lead
JOIN OUR TEAM
Does this position interest you?

If you are interested in joining our clinical operations team and have a passion for improving health care, apply now!

ACCREDITATIONS