Job Details

ID #2981445
Estado Florida
Ciudad Tampa bay area
Full-time
Salario USD TBD TBD
Fuente Florida
Showed 2019-12-08
Fecha 2019-12-04
Fecha tope 2020-02-02
Categoría Salud
Crear un currículum vítae

Clinical Review Nurse (Tampa Bay, FL)

Florida, Tampa bay area 00000 Tampa bay area USA

Vacancy caducado!

CLINICAL REVIEW NURSE

WAGE: $32/HR

LOCATION: TAMPA, FL

CONTRACT 1ST SHIFT

The Clinical Denial Utilization Review Nurse responsible for conducting clinical reviews to justify and dispute payer denials. The role will develop case studies, coordinate with hospital operations and payers to ensure optimal results in denial prevention. The clinical denial coordinator will oversee quality assurance for clinical denials, including development of protocol and training.

Provide clinical argument, using available Medical Records, to justify and dispute payer denials, all levels of appeals included.

The Clinical Denial Utilization Review Nurse is responsible for conducting clinical reviews to justify and dispute payer denials. The role will develop case studies, coordinate with hospital operations and payers to ensure optimal results in denial prevention. The clinical denial coordinator will oversee quality assurance for clinical denials, including development of protocol and training.

Develop monthly case studies, identifying payer and hospital operational opportunities

Compile reports as requesting by the ROS client and operations, specific to payers, operations and clinical reviews

Participate in performance meetings as requested by ROS client and operations

Develop and conduct quality reviews of all clinical reviews, including training.

Key Responsibilities:

Provide clinical argument, using available Medical Records, to justify and dispute payer denials, all levels of appeals included.

Develop monthly case studies, identifying payer and hospital operational opportunities

Compile reports as requesting by the ROS client and operations, specific to payers, operations and clinical reviews

Participate in performance meetings as requested by ROS client and operations

Develop and conduct quality reviews of all clinical reviews, including training.

MINIMUM SKILLS:

5 Years Utilization Review or Case ManagementÂ

CRITICAL SKILLS:

Extensive knowledge in evidence-based protocol “ Hospital Case Management

Excellent verbal and written skills

Ability to analyze and present to both leadership and operational teams

Microsoft Office:Â Excel, Word, PowerPoint

EDUCATION:

Bachelor of Science in Nursing or Utilization or Case Management

Current valid State of Florida or multi state license as a Registered Nurse

Vacancy caducado!

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2019-12-04