Are you a Registered Nurse with experience conducting appeals and denials? Then send your updated resume to [ Email address blocked ] - Click here to apply to Utilization Management RN
. Honestly, everyone can send me their resume because then we can save some time and discuss available roles based on what you're looking for.
Title: Utilization Management RN
Location: Remote but must be located in: TN, GA, AL, MS or NC
Hours: M-F day, Business hours
Length of Engagement: Contract 3+ months
Rate: Competitive and Dependent on Experience
- RN License in Tennessee or Compact State
- At least 2 years varied clinical experience
- Utilization management (Payor side)
- Excellent computer skills
- Recent acute care hospital experience
- Knowledge of CMS guidelines
- Writing CMS denial letters and letters for Medicare
- Experience reviewing for approval/denial for Medicare and authorization requests.
- Performs comprehensive reviews of authorization requests using CMS and MCG guidelines
- Performs thorough research and provides complete documentation.
- Initiate referrals to accomplish discharge planning.
- Assist non-clinical staff in performance of administrative reviews.
- Interact with Onsite and Case Management areas to ensure smooth transfer of member information across the continuum of care.
- Apply established vendor protocols for authorization processes
I look forward to hearing from you!
Recruiter, The Judge Group