Telephonic Utilization Management Nurse Reviewer

eviCore healthcare
Nashville, TN
Oct 04, 2017
Jobs Outside Higher Education
Other Jobs Outside Higher Education
Institution Type
Outside Academe

Job Description

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

Company Description
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.

Nashville, TN


Tue, 3 Oct 2017 07:00:24 PDT