ACCESS REP II - UTILIZATION REVIEW in San Diego, CA at Scripps Corporate Offices

Date Posted: 9/12/2018

Job Snapshot

Job Description

Change Lives, Starting with Yours
At Scripps Health, you will experience the pride, support, respect that has been repeatedly recognized as one of the nation’s Top 100 Places to work.
You’ll be surrounded by people committed to making a difference in the lives of their patients and their teammates.  So if you’re open to change, go ahead and unlock your potential.
Truven Health Analytics named Scripps Health among the top five large health systems in the nation. Scripps was the only California health care system on the Truven Top 15 Health Systems list this year. This is the fifth time Scripps has received the honor.
As AR II, you will be responsible for working assigned queues, including making review determinations for referrals/authorizations on internal criteria list level. Play an integral role by working with ACO and Managed Care Place to coordinator patients into and out of SNF.  You'll assume responsibility for the preparation of authorization requests for internal RN review or external Health Plan review including obtaining appropriate medical records, Health Plan/Milliman criteria, benefit coverage information and forwarding to the appropriate reviewer. You will enter review decisions in IDX and act as a resource for referral/authorization questions from Health Plans and clinic staff.

Job Requirements

Experience/Specialized Skills:
  • Minimum of 3 years experience in a managed care setting preferably in utilization review.
  • Minimum of 1 year experience with the IDX system preferred. Working knowledge of Word, EXCEL, and Internet.
  • Familiarity with medical terminology and coding required.
  • Strong organizational skills.
  • High level of independence and problem solving skills.
Required Education/Course(s)/Training:
  • High School Diploma.
  • College or vocational class completion in medical terminology and coding classes preferred.
Scripps Health is repeatedly named on the Fortune Magazine’s 100 Best Companies to work for, only San Diego-based Company and Becker’s Healthcare Top Hospitals. Scripps Health offers a robust Total Rewards Program designed to compensate and motivate you throughout your career. Scripps Health Total Rewards Program includes a broad range of plans and programs including market competitive pay and performance incentives, health and wellness benefits, financial wellness benefits, work-life resources, learning and development opportunities, and rewards and recognition. Unlock your potential with Scripps Health today.

Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.