Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Bilingual UR Review Nurse - Doral

Expired Job

Cigna Doral , FL 33166

Posted 2 months ago

Job Title: Bilingual Utilization Review Nurse

Job Summary:
To review requests for coverage of outpatient and inpatient medical services, request additional clinical information as needed, review applicable coverage guidelines, approve services that meet established criteria or forward requests to medical director for secondary review.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
1.Review requests for medical services that require prior authorization as per LMCHP/Medicare guidelines and timeframes, including both outpatient and inpatient services.
2.Contact requesting providers to obtain additional information when needed to establish medical necessity.
3.Might conduct on-site concurrent reviews at inpatient hospitals/units, to establish medical necessity of services being rendered.
4.Approve requests that fulfill LMCHP and Medicare coverage guidelines or forwards cases that require additional review to Medical Director
5.Answer telephonic inquiries from medical directors and providers regarding the status of organization determinations.
6.Maintain open channels of communication with requesting providers, attending physicians and business partners.
7.Comply with Leon Medical Centers Health Plans, Medicare and State policies and procedures and maintain confidentiality of member information in accordance with state and federal laws.
8.Participate in mandatory trainings and competency testing as required.
9.Maintain up-to-date clinical knowledge.
10.Perform other related duties assigned.

QUALIFICATIONS:

Required:

  • Registered Nurse with unrestricted Florida License

  • 2 or more years of experience in a clinical setting

  • Fluency in spoken and written Spanish

Preferred:

  • One or more years of experience in utilization review

  • Extensive knowledge of Medicare guidelines

  • Bachelor's level education

See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Download the
LiveCareer app and find
your dream job anywhere
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Restaurant Team Member Crew (2489 Doral 87Th Avenue)

Chipotle Mexican Grill

Posted 2 weeks ago

VIEW JOBS 10/25/2018 12:00:00 AM 2019-01-23T00:00 Restaurant Team Member - Crew (2489 - Doral 87th Avenue) (18027618) Description At Chipotle, we've created something special: a better place to eat and work. Many employees start just expecting a paycheck, but end up with a rewarding career. We provide exceptional training and a clear career path – over 80% of our managers got promoted from Crew. What's in it for you: * Tuition assistance (up to $5,250 a year) * Free food (yes, really FREE) * Medical, dental, and vision insurance (for everyone) * Paid breaks * Paid time off * Holiday closures * Full time and part time opportunities * Opportunities for advancement (80% of managers started as crew) * Customized college degree programs that can be completed in as little as 18 months, for as low as $250 a year* * Competitive compensation, including stock and company car allowance for our highest-performing managers (Restaurateurs) What we're looking for: * Someone with a friendly, enthusiastic attitude * Someone that loves to help and serve others (both customers and team members) * Someone ready to learn how to cook (a lot) We prepare real food by hand every day in our restaurants. No freezers, microwaves or can openers to be found. We welcome experienced restaurant professionals and novices alike. We'll provide the training you need to feel confident working at any station – grill, cashier, prep, salsa and expo. We take pride in our exceptional customer service and it's up to each of our team members to create the friendly atmosphere that our customers expect and enjoy. So, whether you have experience as a dishwasher, cashier, server, host, bartender, cook, prep cook, FOH/BOH or no experience at all, we're always looking for passionate and enthusiastic people to join our team. At Chipotle, you'll be part of a team that is working to cultivate a better world. If that sounds like something you would like to be a part of, apply today. Requirements (the fine print): * You have to be at least 16 years old to work at Chipotle * You need to be able to communicate in the primary language(s) of the work location * Receive up to $5,250 from Chipotle in tuition assistance and up to $5,185 in federal grants each year. Combined with up to 44 earned credit hours from on-the-job training at Chipotle, you could earn your degree for as little as $250 a year. Primary Location: Florida - Doral - 2489 - Doral 87th Avenue-(02489) Work Location: 2489 - Doral 87th Avenue-(02489) 2000 NW 87th Ave, Ste 1 Doral 33172 Job: Restaurant Crew Job Posting: Oct. 11, 2018 Job Number: 18027618 Share this Job * Chipotle Mexican Grill Doral FL

Bilingual UR Review Nurse - Doral

Expired Job

Cigna