Utilization Review Appeals Nurse RN

This outstanding Healthcare Management Support organization is actively interviewing for a Utilization Review and Appeals Nurse RN in the Portland Oregon Area. Join this established health management organization, and help support a huge group of stakeholders across the Western U.S.

Established over 20 years ago, this Medical Review Support organization offers comprehensive tools and services to a wide range of healthcare participants including independent physicians, medical groups, hospitals, ambulatory centers, clinic networks, health plans, and payers. Working with an outstanding team of Medical Review professionals, the Utilization Review and Appeals RN will support efficient operations to many of these partners.

Reporting to the Utilization Review Operations Manager, the UR and Appeals Nurse will play a central role in supporting efficient operations through the chart review and preparation of case summaries on a remote basis. Working closely with physician and nursing partners in writing, over the phone, and in virtual environments, the Utilization and Appeals Nurse will directly support pre-authorization and appeals processes for medical treatments / procedures in more than 50 specialties and sub-specialties.

This role will be based out of the company’s headquarters in Oregon. The Utilization and Appeals Nurse will work in flexible capacity, splitting time between remote work and working from the beautiful office building downtown.

A key responsibility for the Utilization Review and Appeals RN will be in ensuring the accuracy and timeliness of medical record review and case summary. This person will have a strong background in comparing health plan policy to clinical review criteria in order to support physician review and ultimately case determinations. The UR Appeals Nurse will pay close attention to language and grammar, allowing for concise and clear communications across the company. This clarity is particularly important if the Utilization Review RN decides to work on a remote basis.

The Greater Portland Area is quickly becoming one of America’s prime destinations, and it’s easy to see why. If local to the area, the Utilization Review and Appeals Nurse RN will discover an affordable cost-of-living, close proximity to some of the country’s best schools, and a growing economy, making this region a great place to think about family. World-class cuisine, a legendary music scene, a nationally recognized craft beer and cocktail industry, and a long history of artistic culture will keep the city folks happy to the core. A short trip in any direction puts you square in the middle of the most beautiful nature the West Coast has to offer. From the snowy slopes of Mt. Hood, the rocky Oregon Coast, the outdoorsy type will find plenty to keep them happy.

The Appeals and Utilization RN will play a direct role in realizing the organization’s growth and development plans. You’ll get the opportunity to work with a wide array internal and external partners, driving the organization’s mission with every decision. For the dedication and hard work that this role will require, the UR and Appeals RN will receive a generous benefits package, a competitive compensation, and the job security that comes with a growing and healthy organization.