Telephonic Utilization Management Nurse Reviewer
Looking for qualified candidates who can start on 1/23/17.
- The Telephonic Utilization Management Nurse Reviewer will conduct clinical review to determine medical necessity of Post-Acute Care services utilizing appropriate guideline/criteria for precertification of requested services.
- Position is located in Franklin, TN or a remote location
- Position is full-time during core business hours with the ability to work any shift between 7am and 6pm CT, plus potential of on call responsibility after business hours
- Ability to sit at a desk 90% of the time and utilize the computer, telephone, and other office equipment, throughout the entire work day
- Dependable and reliable work schedule is essential
- Current unrestricted Registered Nurse licensure and ability to obtain licenses in other states
- Certified Case Manager (CCM) preferred
- Minimum 5 years' clinical experience
- 2 - 4 years' experience in utilization and case management
- Post-Acute facility experience preferred
- Medicare/Medicaid managed care program experience preferred (especially Medicare Advantage)
- CMS guidelines for post-acute services including home health and DME
- ICD diagnostic coding and CPT procedural coding, InterQual and CMS guidelines
- Intermediate computer literacy skills with ability to use and troubleshoot Microsoft Word, Excel, Outlook, and PowerPoint required
- Experience using videoconferencing systems such as WebEx
Specifically designed with the size and scale to address the complexity of today's and tomorrow's healthcare system, eviCore is a company committed to advancing medical benefits management and enabling better outcomes for patients, providers, and plans.
Ours is an evidence-based approach that leverages our exceptional capabilities, powerful analytics, and an acute sensitivity to the challenges and needs of everyone involved across the healthcare spectrum. Applying proven talent and leading-edge technology, we harness healthcare's evolving demand and inherent change to realize and deliver improved results for everyone.
Tue, 3 Oct 2017 07:00:24 PDT