The Clinical Nurse Reviewer is responsible for reviewing authorizations in the medical director queue. The goal of the Clinical Nurse Reviewer is to maintain regulatory turn around times, ensure correct guidelines are utilized for the request, and appropriately steer the requests to utilized network providers and appropriate place of service (where applicable). This position helps maintain appropriate utilization and to support the network providers, all with an eye on quality patient care.

Essential Duties and Responsibilities include the following:The goal of the Clinical Nurse Reviewer is to effectively review prior authorizations, providing updated criteria and necessity, utilizing the appropriate tools and reviewing diagnostics.

Qualifications

• High school graduate required; Nursing degree required.
• 2+ yrs of Healthcare and Managed Care preferred.
• Typing 60 words per minutes with accuracy.
• Knowledge of computers, faxes, printers and all other equipment.
• Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point).
• Ability to deal with responsibility with confidential matters.
• Ability to work in a multi-task, high stress environment.

About the Hospital

As one of the largest physician-led networks in Southern California, we have thousands of physicians and hundreds of hospitals committed to providing quality healthcare to all of the communities we serve.

Every day, our employees are inspired to make a difference in the lives of others as well as transform their own experiences to achieve a higher sense of fulfillment. Our employees become a part of an extraordinary team of people dedicated to health, wellness, and happiness for themselves and others. There is no greater reward than contributing to a positive work environment where compassion, understanding, care and attention are encouraged and valued.