Healthcare Careers

THE HEALTHCARE INITIATIVE 

Where Talent Meets Opportunity 

Interim Referral Nurse (Remote)

California

Join a community-based Healthcare organization looking for Interim Referral Nurse to review and verify authorizations and supporting documentation for eligibility, codes and clinical notes. The referral nurse will obtain required documentation and information from a variety of internal and external sources. Evaluates orders to see if they meet established medical guidelines, and approves, defers or escalates to Medical Director for review. Monitors deferrals and escalated requests to ensure timely responses. Creates timely communications of denials, approvals with modifications and deferral letters using standard templates; submits for approval and distributes.  This position works closely with and reports to the Referral Nurse Lead.

Interim Details:

• 3–4-month Interim assignment position. 
• Able to work remotely,
• Must be a “current” resident of California

Position Requirements:

• Bachelor’s degree in nursing, required
• Unrestricted California Registered Nurse license or Vocational Nursing License, required
• 2+ years clinical experience as a nurse in an acute care setting in ER/ICU/Med-Surg or PCU, required
• Strong clinical nursing skills set following California’s Scope of practice guidelines, required.
• Working knowledge of Medi-Cal and/or Medicare populations, strongly preferred
• General knowledge of NCQA Standards for referrals and authorizations, strongly preferred.
• Strong conflict resolution skillset utilizing tact and diplomacy, required.

Key Characteristics: 

• Critical thinking skills
• Work Independently/Self-motivated
• Process Management
• Time Management
• Strong written and verbal communication skills

This west coast location offers many outdoors areas to explore and enjoy while being centrally. located to a re-known university, a wide variety of sporting events, a variety of museums and some of the best dining in the United States.

To apply or schedule a confidential phone conversation, please send your resume (MS WORD format preferred) to alison@thi-search.com or call 720-735-9739