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Appeals Review Nurse

A Line Staffing Solutions

This is a Contract position in Beacon, NY posted October 12, 2021.

Concurrent Review Nurse openings with a major health insurance / managed care company based in the Atlanta, GA area Starting ASAP Apply now with Jake Z at A-line jzambutoalinestaffing.com Position will be remote / work-from-home until at least September and will eventually return to in office Job Responsibilities: Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care Conduct discharge planning Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems For New Hampshire and Massachusetts
– home visits required Pay Rate: $38-42 per hour dependent on experience Hours: Monday – Friday from 8:00am-5:00pm Required Experience: Education/Experience: Graduate from an Accredited School of Nursing.

Bachelor’s degree in Nursing preferred Current state’s LPN/LVN or RN license.0-2 years of experience Preferred Experience: Worked in managed care organization in a Utilization Management role handling Medicare review Associate’s or Bachelor’s degree in Nursing highly preferred.

Interqual experience and UM experience preferred Why Apply: Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability 401k after 1 year of employment: With employer match and profit sharing GREAT Hours 40 hours per week, Monday-Friday, No Weekends, Potential Overtime Competitive Pay Rate​ Keywords: Prior Authorization Nurse, PA Nurse, Medicare, Medicare Review, CMS, Medicaid, BSN, ASN, ADN, MSN, Case Management, URAC, Authorization Nurse, Intake Coordination, Discharge Planning, Utilization Management, Utilization Review, Home Healthcare, Medical Billing, Medical Coding, Provider Services, Member Services, CMS, Managed Care, MCO, Benefit Verification, LVN, Licensed Vocational Nurse, Clinical Care, Clinical Service, Clinical Coordinator, Nurse, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Reimbursement Counselor, Medical Customer Service, Healthcare, Inbound Calls, Outbound Calls, Medicare, Medicaid.