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Nurse Reviewer I
Job Description:
American Imaging Management (AIM) is the nations leading provider of diagnostic imaging management services. Our clinical operations group seeks a experienced nurses to join our collegial team of Nurse Reviewers in AIMs modern Westchester, IL contact center.
Nurse reviewers are responsible for conducting preauthorization, out of network and appropriateness of treatment reviews for diagnostic imaging services by utilizing appropriate policies, clinical and department guidelines. They collaborate with healthcare providers, and members to promote the most appropriate, highest quality and effective use of diagnostic imaging to ensure quality member outcomes, and to optimize member benefits.
- Receive preauthorization requests from front-line Referral Specialists through direct call transfer
- Conduct initial medical necessity clinical screening
- Determine if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review
- Conduct initial medical necessity review of exception preauthorization requests for services requested outside of the client health plan network
- Verbally notify ordering physician or rendering service provider office of the preauthorization determination decision
- Document the results of the initial clinical review and determination in the precertification computer system.
- Disseminate faxes to providers to request additional clinical information as applicable
- Maintain confidentiality of patient and provider specific information
- Maintain telephone service standards in accordance with pre-established departmental performance metrics
Founded in 1989, AIM is one of the oldest and largest companies in the radiology benefit management industry. A proud member of the WellPoint family of companies, AIM partners with leading health plans and health care providers to promote the most appropriate use of outpatient diagnostic imaging through the application of widely accepted clinical guidelines delivered through responsive, customized solutions, a commitment to clinical excellence, and industry leading, innovative technologies.
We maintain offices in Chicago, Deerfield, Schaumburg and Westchester, IL as well as Glendale, CA. This position will be located at our Westchester, IL offices.
Along with a dynamic, entrepreneurial work environment, AIM offers competitive compensation, a generous benefits package and the opportunities for career progression youd expect from an industry leader.
These benefits include:
- An array of Health, Dental and Vision Care Insurance plans
- Term Life Insurance
- Short- and Long-term Disability Insurance
- 401(k) Employee Savings Plan with company match
- Stock purchase plan
- Paid Time Off
- Tuition Reimbursement Tax-advantaged health care and dependent flexible spending plans
- Health club reimbursement allowance
- Licensure reimbursement for medical professionals
Job Requirements:
- Graduate of an accredited school of nursing
- Registered Nurse with a current, valid unrestricted license in the state of Illinois
- Minimum of three (3) years recent clinical nursing experience in an ambulatory or hospital setting
- Familiarity with managed health care programs including HMO, PPO, and POS
- Familiarity with Utilization Management Guidelines preferred
- Familiarity with ICD-9 and CPT 4 coding preferred
- Previous utilization and/or quality management and/or call center experience helpful
- Candidates should have good computer skills and solid typing speed and accuracy
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