Job description

Motion Picture Industry Pension & Health Plans (MPI) is an equal opportunity employer and does not discriminate against any applicant or employee on the basis of race, religion, color, national origin, ancestry, sex, sexual orientation, gender identity, age over 40, marital status, veteran status, mental or physical disability, pregnancy, genetic information, or any other basis prohibited by law. Any applicant who, because of disability, requires accommodation or assistance in completing this application or at any time during the application process should contact the Human Resources Department. MPI also provides reasonable accommodations to disabled employees consistent with its obligations under applicable law.

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.
For consideration, qualified candidates should submit a resume, letter of interest, and salary requirements.
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.
• Ability to work overtime/extended hours as required.
• Experience with MS Office (Outlook, Word, Excel), Internet Explorer QNXT, WebXtender Imaging System.

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.

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

We are an Equal Opportunity Employer

Job Type: Full-time

Pay: $36.00 - $40.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Free parking
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Standard shift:

• Day shift

Supplemental schedule:

• Overtime

Weekly schedule:

• Monday to Friday

Work Location: One location

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