Clinical Review RN PRN
$76,960–$76,960 year
On-siteCamden, New Jersey, United States
Job Summary
Utilize payer-specific screening tools to determine level of service and medical necessity, performing utilization reviews in accordance with state regulations. Consult with Physician Advisors regarding length of stay and care appropriateness, while identifying and managing concurrent and retroactive denials through communication with attending physicians, case management, and external resource groups. Complete documentation of review and denial processes in the EPIC Case Management Module, responding to payer requests for information and treatment plans. Review and validate physician orders, reporting progress and unusual occurrences to the payer. Requires current NJ-RN license, 3-5 years of clinical experience, and Monday availability.
Required Qualifications
- 3-5 years of recent clinical experience
- Current NJ-RN License
- Monday availability
Desired Qualifications
- Experience in utilization management or review
- Knowledge and understanding of disease protocols and clinical pathways for commercial and government payors
- Familiarity with Interqual and Millimen guidelines and regulatory mandates
- Bachelor's degree in Nursing
- Strong communication (written and verbal) and critical thinking skills
- Professional and effective presentation skills
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.