Clinical Review RN PRN

Cooper University Hospital•Camden, NJ

2d•$37 - $61•Remote

About The Position

Cooper University Health Care is committed to providing extraordinary health care, starting with its team. Extraordinary professionals continuously discover clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies, and research protocols. Cooper offers full and part-time employees a comprehensive benefits program, including health, dental, vision, life, disability, and retirement. Attractive working conditions and opportunities for career growth through professional development are also provided. Cooper University Health Care is the employer of choice in South Jersey.

Requirements

3-5 years of recent clinical experience, preferably in area of population specialty.
Knowledge and understanding of disease protocols and clinical pathways for commercial and government payors.
Strong communication (written and verbal) and critical thinking skills required.
Professional and effective presentation skills required.
Current NJ-RN License required.
Monday availability is required.

Nice To Haves

Experience in utilization management or review preferred.
Familiarity with Interqual and Millimen guidelines and regulatory mandates preferred.

Responsibilities

Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity.
Performs utilization review in accordance with all state mandated regulations.
Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues.
Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers.
Completes documentation of review and denial processes in the EPIC Case Management Module.
Responds to requests from the payer for all required information and treatment plans.
Reviews and validates physician’s orders, reports progress and unusual occurrences on patients to the payer.