RN Utilization Review - Patient & Family Services - Per Diem

SolutionHealth • Nashua, NH

2d • Onsite

About The Position

The Utilization Review/Denial Specialist works with the care team to evaluate medical acuity for the appropriate level of care orders and documentation to facilitate insurance coverage, and proactively prevent denials. This specialist ensures level of care charges are applied accurately and meet compliance with CMS and commercial insurance guidelines as well as reviewing appeal options for medical necessity insurance denials.

Requirements

• Current NH Nursing License as a Registered Nurse.
• ASN accepted; BSN required within 10 years of hire.
• A minimum of 5-years' of experience as a Registered Nurse.

Nice To Haves

• Experience in use of Interqual, Milliman or other Healthcare acute criteria preferred.

Responsibilities

• Assess acute medical necessity utilizing appropriate criteria.
• Collect and trend Utilization Review data metrics.
• Review appeal options for commercial insurance, RAC, and QIO medical necessity denials.
• Understand and apply CMS Regulations to meet compliance

Benefits

• Health, dental, prescription, and vision coverage for full-time & part-time employees
• Short-term, long-term disability, life & pet insurance
• Student Loan Forgiveness & Discounts
• 403(b) Retirement savings plans
• Continuous earned time accrual

What This Job Offers

• Job Type: Part-time
• Career Level: Senior
• Education Level: Associate degree