Nurse Reviewer - Glendale, CA

Use your clinical nursing skills in a collaborative office environment

at American Imaging Management

Family-friendly scheduling means:

No overtime, no weekend, no holidays

American Imaging Management (AIM) is the nation's leading provider of diagnostic imaging management services.  Our clinical operations group seeks experienced nurses to join our collegial team of Nurse Reviewers in AIM's expanding Glendale, CA 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 Glendale, CA offices,  convenient to the Golden State Highway and Ventura and Glendale Freeways.

Along with a dynamic, entrepreneurial work environment, AIM offers competitive compensation, a generous benefits package and the opportunities for career progression you'd 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

Our total rewards package is designed to attract, motivate and retain qualified individuals.  Whether you are interested in medical utilization management, nursing, information technology, accounting and finance, marketing or human resources, there may be an opportunity for you at AIM. As an Equal Opportunity/Affirmative Action employer, we are committed to promoting diversity in the workplace.

AIM 's services include:

• Prospective clinical review of outpatient advanced imaging procedures such as CT, MRI, Nuclear Cardiology and PET Scans
• Outpatient diagnostic imaging provider network analysis and transparency
• Claim adjudication and provider payment services

 Our programs combine clinical excellence, innovative technology and a commitment to customer service, ensuring the company's on-going leadership in the rapidly evolving healthcare environment.

AIM is certified by the National Committee for Quality Assurance (NCQA) and has received Full Accreditation for Health Utilization Management from the Utilization Review Accreditation Commission (URAC.)

Qualifications for consideration:

• Graduate of an accredited school of nursing
• Registered Nurse with a current, valid unrestricted license in the state of California
• 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