AR II - UTILIZATION REVIEW - Full-Time - Day in San Diego, CA at Scripps Corporate Offices

Date Posted: 2/11/2018

Job Snapshot

Job Description

Responsible for working assigned queues, including making review determinations for referrals/authorizations on internal criteria list level. Responsible for 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. Enter review decisions in IDX. 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. 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.
Preferred Experience: Minimum of 1 year experience with the IDX system preferred. 

Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, age, status as a protected veteran, among other things, or status as a qualified individual with disability.