RN Utilization Management - Telephonic

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POST DATE 8/14/2016
END DATE 11/14/2016

ALL's WELL North Fort Myers, FL

Job Classification
Full Time
Company Ref #
Required Licenses/Certifications
North Fort Myers, FL
Job Type
AJE Ref #


New opportunity for experienced Utilization Review RN's!

Telephonic/work from home full time position

40 hours a week Mon-Fri 8a-5p.

Hiring RN's with a minimum of three years clinical experience as an RN at the facility level as well as experience in Utilization Review, Concurrent Review, Pre/Post Service Medical Review, Healthcare Appeals/Disputes Analyst RN, Clinical Quality Improvement RN, Home Health, Discharge Planning both telephonically and at the facility level, SNF/LTAC and Managed Care.


?Experience completing utilization review and working knowledge of InterQual, Milliman Guidelines, CMS, LCD/NCD , NCQA and/or other decision making criteria tools

? CPT and ICD coding, claims components(post Service), Medical Member Provider and Appeals knowledge and experience

?Medical Member and Provider Appeals, Managed Care knowledge and experience

?Analyze and advise claims, identify questionable medical practices
Ensure medical necessity and experimental/investigational claims were processed correctly according to multiple coverage guidelines


? Clear/Active FL RN License

? Resident of Florida

?3 years of experience conducting UM review and discharge planning at the facility level ( SNF, LTAC, ALF) as an RN

? Proficient in Microsoft Word, Excel, Outlook

? Must have hard-wired/high -speed internet, home computer

? Must be a current resident of Florida

? BSN highly preferred, bilingual Spanish preferred

If you have the required experience and are interested in applying for this position please respond with your cv and resume. (applicants who do not have the required previous experience will not be considered). We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.