RN - Utilization Reviewer
Posted on Apr 17, 2019 by CHI St. Alexius Health
This position provides clinical expertise and knowledge of appropriate utilization management, managed care guidelines, Medicare and Medicaid rules and level of care criteria. Other responsibilities include concurrent and retrospective reviews, denials, appeals, physician advisor referrals and staff education.
Required Minimum Experience
Minimum of three ( 3) years of broad clinical experience
Required Minimum Knowledge, Skills and Abilities
Knowledge of case management, working of Medicare, Medicaid and private insurance. Ability to interact professionally with staff, physicians and payers. Working knowledge of software tools used for utilization. Ability to establish priorities, meet deadlines and maintain productivity standards in the management of the work assigned.
Ability to form positive, collaborative relationships with hospital staff, patients, families and insurance companies. Ability to problem solve
In a proactive, creative manner, using sound judgment based on factual information and clinical knowledge. Ability to effectively negotiate with internal and external providers of patient care services.
PREFERRED Education and/or Experience
Clinical nurse experience with hospital and /or medical background
- Requisition ID:
- Schedule: Full-time
- Shift: Variable
- Market: CHI St. Alexius Health