RN Utilization Appeals Nurse

Staff positions forUtilization Review - Clinical Appeal Nurses

1) Research medical records and compose (in conjunction with a physician reviewer when indicated) clinically-based, medical necessity appeals to overturn payor denials, as assigned;
2) Follow-up on all appeals for determinations and additional actions/resolution;
3) Coordinate commercial/managed care audit requests, as assigned;
4) Validate and compile audit findings; and
5) Exit/finalize all completed audits, as requested.

Requirements are an LPN or RN with experience as a beside nurse, and preferable case management experience with experience with payor appeals and utilization review.

Don't Be Fooled

The fraudster will send a check to the victim who has accepted a job. The check can be for multiple reasons such as signing bonus, supplies, etc. The victim will be instructed to deposit the check and use the money for any of these reasons and then instructed to send the remaining funds to the fraudster. The check will bounce and the victim is left responsible.

More Jobs

Utilization Management Nurse Consultant (RN)- ...
Allentown, PA Aetna
Utilization Management Nurse Consultant (RN)- ...
Blue Bell, PA Aetna
RN/LPN Charge Nurse Full Time 11-7
Philadelphia, PA Caring Heart Rehabilitation and Nursing Ce...
RN/LPN Charge Nurse Part Time 3-11 Shift
Philadelphia, PA Caring Heart Rehabilitation and Nursing Ce...
RN-Gettysburg Hospital -Nursing Resource Team ...
Gettysburg, PA Wellspan Health System
RN-Telemetry - Travel Nursing: TelemetryTravel...
Sayre, PA RNNetwork