Utilization Review Clinician (RN, PT, OT) - Oregon
WellSkySalary not specified
- Full Time
- Junior (1 to 2 years)
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Health Insurance, Healthcare ServicesIndustries
Requirements
Candidates must possess a Registered Nurse (RN) license, along with a minimum of five years of experience providing direct patient care, ideally within a hospital setting, and experience in medical billing and/or coding, such as in provider or payor settings. Strong written communication skills, including the ability to draft letters for members, patients, and providers, are also required.
Responsibilities
As a Utilization Review Nurse, you will evaluate the medical necessity and quality of healthcare services for members using Milliman Care Guidelines, participate in quality improvement initiatives, ensure compliance with clinical guidelines and regulations, review and analyze medical records, evaluate good faith estimates, collaborate with healthcare providers, draft letters to members, review claims reconsiderations and appeals, and assess claims for balance billing protections.
Skills
Registered Nurse (RN)
Medical Billing
Medical Coding
Clinical Guidelines
Medical Record Review
Healthcare Compliance
Provider Collaboration
Claims Review
Sidecar Health
Affordable health insurance with price transparency
About Sidecar Health
Sidecar Health provides health insurance plans that focus on affordability and transparency, including options compliant with the Affordable Care Act (ACA). The company allows members to see average cash prices for medical services upfront, helping them make informed decisions and avoid unexpected costs. Revenue is generated through member premiums, which cover medical expenses, while also benefiting from the difference between negotiated cash prices and premiums. Sidecar Health's goal is to empower members to take control of their healthcare expenses with straightforward and cost-effective insurance options.
Key Metrics
El Segundo, CaliforniaHeadquarters
2018Year Founded
$319.1MTotal Funding
SERIES_DCompany Stage
Financial Services, HealthcareIndustries
201-500Employees