RN Utilization Review Patient & Family Services Per Diem
Job Location:
Nashua, NH - USA
Monthly Salary:
Posted:
Application Deadline:
Vacancies:
Job Summary
Come work at the best place to give and receive care!
Job Description:
This Role is On-Site
Who We Are:
Southern NH Medical Centers strives to keep patients on a continuous track to discharge and receive the continuity of care that our patients and their families need. Our Patient and Family Services Department is the driving force to assure communication respect and safety follows our patients throughout the admission phase all the way through the discharge process. This department includes a dedicated team of Case Managers Social Workers and Interpreters that ensure that all care is equal and our patients dignity is maintained above all else.
About the Job:
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
What Youll Do:
- 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 CMSRegulations to meet compliance
Who You Are:
- 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.
- Experience in use of Interqual Milliman or other Healthcare acute criteria preferred.
Why Youll Love Us:
- 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
Work Shift:
Per diem weekends and holiday. Other days available if staff have availability.SolutionHealth is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation disability status veteran status or any other characteristic protected by law.
About Company
Southern New Hampshire Health - Premier medical center and a network of over 400 providers in more than 50 convenient locations.
