Clinical Data Services Representative
Clinical Data Services Representative
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Job Description
Job Title: Registered Nurse (H&PS)
Work Location: Austin TX (Local Candidates Preferred - Remote)
Offering Description:
MUST BE ABLE TO WORK 10A to 7P SHIFT. No direct patient care. 8-hour shifts unless OT is needed and approved. Will have a shift between 7am and 7pm so must be available for all shifts between that time.
Process Description:
RN conducts pre-service concurrent retrospective reviews. Collaborate with healthcare providers promote quality member outcomes optimize member benefits promote effective use of resources. Ensure medically appropriate high-quality cost-effective care through assessing medical necessity of outpatient services out of network services and appropriateness of treatment setting within scope of professional limitation.
Skills Description:
- Utilize the applicable rules of the Texas Administrative Code (TAC).
- Review Medical Necessity requirements.
- Would be nice to have skills:
- Microsoft Word
- Excel
- Work and Excel
Roles and Responsibilities:
- Registered Nurse conducts pre-service concurrent retrospective reviews.
- They will collaborate with healthcare providers to promote quality member outcomes to optimize member benefits and to promote effective use of resources.
- They will ensure medically appropriate high-quality cost-effective care through assessing the medical necessity of outpatient services out of network services and appropriateness of treatment setting within the scope of professional limitations.
Employment Type
Full-time
