RN Utilization Review - Telephonic
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 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.
Must have experience with the following job responsibilities
?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)
? Proficient in Microsoft Word, Excel, Outlook
? Must have hard-wired/high -speed internet, home computer
? 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. We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.