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Utilization/Appeals Review Nurse

Location: Portland, OR
Job Code: 287
# of Openings: 0

Description

UTILIZATION REVIEW NURSE  

 

  • 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 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.   

 

We are 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

 

In this role, you will work closely with our medical directors and national peer physician specialists 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. 

 

Position Description 

 

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  

 

 

 

 

BENEFITS 

AllMed offers generous compensation, and our competitive benefits program includes comprehensive medical and dental care, matching 401K, paid time off, flexible spending accounts, disability coverage, and other benefits that help provide financial protection. 

 

 

AllMed provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, AllMed complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. 





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(800) 400-9916
111 SW Fifth Ave., Suite 1400, Portland, OR 97204
AllMed Healthcare Management, Inc. All rights reserved.

AllMed is an independent review organization with a panel of 400 physician peer reviewers who are licensed, board-certified and in active practice, covering more than 80 ABMS specialties and sub-specialties. AllMed offers medical, copy-editing and customer resources that enable clients to improve quality of care and patient safety.