Job Description
Scope of Work
This role includes accountability for utilization review (UR) and may include admission, concurrent, and retrospective reviews. Coordinates activities involved in the certification, recertification, and concurrent appeals process, conducting referrals for 2nd level review, as needed. Ensures timely communication with payers based on adequate and complete documentation received by the physician/provider and utilization reviews. Initiates concurrent appeals to address patient class/status downgrades or clinical denials related to medical necessity.
Qualifications
+ Required Associate's Degree Associates or technical degree.
+ Preferred Bachelor's Degree in nursing or related field.
+ 2 years of relevant experience 2 years of experience in clinical/hospital setting. Required
+ Hospital utilization review/utilization management experience. Preferred
+ Cli...
This role includes accountability for utilization review (UR) and may include admission, concurrent, and retrospective reviews. Coordinates activities involved in the certification, recertification, and concurrent appeals process, conducting referrals for 2nd level review, as needed. Ensures timely communication with payers based on adequate and complete documentation received by the physician/provider and utilization reviews. Initiates concurrent appeals to address patient class/status downgrades or clinical denials related to medical necessity.
Qualifications
+ Required Associate's Degree Associates or technical degree.
+ Preferred Bachelor's Degree in nursing or related field.
+ 2 years of relevant experience 2 years of experience in clinical/hospital setting. Required
+ Hospital utilization review/utilization management experience. Preferred
+ Cli...
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