Utilization Management RN - Remote
Posted by Guidehouse • United States, United States, United States
About the Role
Job Family:
Clinical Appeals Nurse
Travel Required:
Clearance Required:
What You Will Do:
Performs chart review of identified patients to identify quality, timeliness and appropriateness of patient care
Conducts admission reviews for Medicare, Medicaid beneficiaries, as well as private insurers and self-pay patients, based on appropriate guidelines
Uses these criteria guidelines to screen for appropriateness for inpatient level of care or observation services based on physician certification
Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis
Performs concurrent and retrospective clinical reviews with various payers, utilizing the app...
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