Utilization Review LVN/RN

Job Description

• Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
• Conducts prior authorization reviews to determine financial responsibility
  

Qualifications

• 2 years Inpatient background with Hospital Nursing (Med-Surg, ER)
• Well versed in Utilization Management - Must be able to determine elective vs urgent request with Prior Authorization Review 
  
• Provider Claims, Appeals and Denials - certain services require prior authorization (PA) from the Utilization Management (UM) department
• 6 + months of Interqual experience
• 6+ months of Coding with ICD10 and CPT/ HCPCS

Additional Information

Interested in being considered? 

If you are interested in applying to this position, please click the Green I’m Interested Button to email your resume and contact Jeff St Louis 407-478-0332x223. 

Company Description

Why You Should Work For Us:

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!