Job description

Utilization Review Nurse
COMPANY

Trajectory is the largest revenue cycle management company in Wichita, KS. We provide revenue cycle management for clients throughout Kansas managing over $250,000,000 in cash collections per year. We have grown by 50% in each of the last 5 years. This allows us to offer significant opportunity for advancement to those team members that prove excellence and meet our cultural imperatives of teamwork, client focus, and Pursuit of Awesome.

We believe our quality of service begins with our quality of team member. We offer exceptional benefits and working environments to exceptional employees. We are seeking a qualified Utilization Review Nurse. The qualified candidate will have experience coding multiple specialties, be self-motivated, positive and detail oriented. Job functions include the following.

ESSENTIAL FUNCTIONS
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• Conducts timely; Precertification, Concurrent and Discharge reviews (Peer reviews and eligibility checks as necessary) as well as retro reviews and appeals as needed.

• Organizes and communicates information necessary to complete daily reviews. Clinical request should be sent to facility prior to 11am.

• Communicates necessary information with management and billing to ensure a seamless revenue cycle.

• Conducts audits of client’s charts to ensure compliance with all payers, this includes monthly spot checks.

• Maintains up to date knowledge of insurance payer requirements.

• Keep current and accurate documentation in Salesforce and EMR systems.

• Performs precertification, prior approvals, and monitoring activities for mental health and substance abuse problems

• Acts as a member advocate by expediting the care process through the continuum, working in concert with the health care delivery team to maintain high quality and cost-effective care delivery.

• Determines medical necessity and appropriateness of services using clinical review criteria based information given by providers.

• Accurately documents all review determinations and contacts providers and members according to established time frames.

• Identifies and refers cases that do not meet established clinical criteria to the clinical team leadership

• Performs accurate data entry in order to meet quality goals.

• Communicates information to other staff members as necessary/required.

• Participates in continuing education initiatives.

• Collaborates with Claims, Quality Management and Provider Relations as requested.

• Other duties as assigned.

Qualifications

• Three (3) to five (5) years’ experience in chart analysis and utilization review in the psychiatric and chemical dependency field preferred.
• Good oral and written communication skills required to communicate in a clear and concise manner with patients, physicians, staff, and administration.
• Stable emotional makeup required to work in a fast-paced environment with frequent interruptions.
• Exceptional communication skills, both written and oral, ability to positively influence others with respect and compassion.
• Strong work ethic built on a foundation of proactivity and teamwork.
• Ability to navigate ambiguity with the aid of structured problem-solving techniques.
• Computer proficiency in Microsoft Office

FULL TIME BENEFITS

• Employer sponsored Major Medical
• Employer sponsored Dental
• Employer sponsored Vision
• Accidental Death and Disability insurance
• Short term disability
• 6% 401K matching
• Flexible spending account
• Generous paid time off
• Job Type: Full-time

Job Type: Part-time

Pay: From $22.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Supplemental pay types:

• Bonus pay

Work Location: Remote

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