Lovelace Health Plan is now hiring for a FT Utilization Review Specialist!!
Lovelace Health Plan is part of the family of companies that make Lovelace Health System one of the leaders across New Mexico's health care system. When you work with Lovelace Health Plan, our goal is to improve quality care, and affordable accessible health care for New Mexicans. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and integrated Healthcare System. Lovelace Health Plan has an Utilization Review Specialist - RN.
Responsible for applying professional clinical skills and expertise in the utilization review of health care services for patients, coordinating services between the patient, interdisciplinary team and payer source, to ensure that the patient is receiving the appropriate level of care. Adheres to policies, procedures, and regulations to ensure compliance and patient safety.
Minimum: Associateâ€™s Degree or Diploma of Nursing
Desired: Bachelorâ€™s Degree in Nursing:
Ability to communicate effectively, function independently, manages time efficiently, organize workflow and maintain confidentiality; Ability to balance businessâ€™ needs with patient advocate services. Knowledge of community, state and federal laws, regulations and resources. Strong analytical and problem solving skills.
3 years of clinical practice experience.
Valid NM RN License or valid multi-state compact license Valid NM Driverâ€™s license.
Lovelace Health System consists of Lovelace Medical Center, Lovelace Rehabilitation Hospital, Lovelace Womenâ€™s Hospital, Lovelace Westside Hospital, Heart Hospital of New Mexico at Lovelace Medical Center, the Lovelace Health Plan offering health insurance to 240,000 New Mexicans with access to a wide range of health care providers and specialists across New Mexico, and 11 retail pharmacy locations in Albuquerque, Rio Rancho and Santa Fe.
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