MPI (Motion Picture Industry Pension & Health Plans) is looking for a skilled Professional Nurse Reviewer to join us at MPI. In this role you would be an integral member of the Medical Review team and help to ensure that our Participants receive timely care by addressing and resolving pre-authorizations and other medical claims issues through the use of evidence based guidelines and medical necessity criteria.

Qualifications:

• Hold a current LVN license, and meet on-going continuous education requirements.
• Three years of experience in a clinical healthcare setting and at least one year of experience in utilization review and medical pre-certifications required.
• Must be familiar with ICD-9, ICD-10, CPT and HCPCS coding.
• Experience in Case Management would be a plus.
• Acute sense of detail and critical thinking.
• Experience with MS Office (Outlook, Word, Excel), Internet Explorer QNXT, WebXtender Imaging System.
• Excellent attendance and reliability
• Ability to work overtime or extend hours as required
• Ability to accept direction and developmental guidance from supervisor
• Ability to work with individuals at all levels of the organization

Essential Duties and Responsibilities:

• Use evidence based guidelines and medical necessity criteria to review and resolve preauthorization requests and medical claims related issues
• Understand and utilize the Summary Plan Description to make medical determinations as necessary.
• Work directly with Senior Manager and/or Chief Medical Officer (CMO) to resolve challenging cases.
• When appropriate, route difficult and complex preauthorization requests and claims to specialist/consultants for resolution.
• Provide detailed medical research to the CMO upon request.
• Other duties as assigned.

Submissions will be reviewed; only candidates most closely matching the requirements of the position will be contacted.

MPI does not file visa petitions or sponsor applicants for work visas in this job classification.

The anticipated base salary for this position is $36-$40 per hour. The actual base salary offered will depend on a variety of factors, including without limitation, the qualifications of the individual applicant for the position, years of relevant experience, level of education attained, certifications or other professional licenses held.

About MPI
Located in Studio City, CA, the Motion Picture Industry Pension and Health Plans (MPI) are multi-employer trust funds established by collective bargaining agreements between various employers and over 30 Unions and Guilds representing employees in the motion picture industry.

Recognized as an Employer of Choice for its employee-focused work environment, competitive compensation and benefits, MPI is a recipient of the World at Work Seal of Distinction.

MPI offers free employee health, dental, vision and life insurance ($50/month for family coverage), retirement and pension, and generous paid time off.

Equal Opportunity Employer

Job Type: Full-time

Pay: $36.00 - $40.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Vision insurance

Physical setting:

• Office

Schedule:

• 8 hour shift

COVID-19 considerations:
All employees must be fully vaccinated against Covid-19. Work stations are socially distanced and high touch-point surfaces are routinely sanitized.

Ability to commute/relocate:

• Studio City, CA 91604: Reliably commute or planning to relocate before starting work (Required)

License/Certification:

• LVN (Preferred)

Work Location: One location

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