Utilization Review/Denial Specialist RN
For more than 100 years, Southern New Hampshire Medical Center has honored our mission: to improve, maintain, and preserve the overall health and well-being of individuals living in the greater Nashua area by providing information, education, and access to exceptional health and medical care services. We have literally been at the heart of better health for Greater Nashua. Our main downtown campus, a familiar landmark for generations, has grown along with the Gate City. Today, The Medical Center and our affiliated doctors and services extend across much of southern New Hampshire. Along with our growth has been the opportunity for many to build and enhance their careers within our organization. We encourage the professional and personal development of our employees and are proud of the workplace culture we have developed.
The Utilization Review/Denial Specialist RN works with the care team to evaluate medical acuity for appropriate level of care orders and documentation to facilitate insurance coverage, and proactively prevent denials. He/she ensures level of care charges are applied accurately and meet compliance within CMS and commercial insurance guidelines. He/she reviews appeal options for medical necessity insurance denials.
Associates Degree in nursing. Completion of BSN or higher nursing degree by 2020
Three to five years experience in acute care Utilization Review and Appeal writing
Experience in use of Interqual, Milliman and other Healthcare acute criteria
Excellent writen and verbal communication skills
Competent in Microsoft Office and general computer skills
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law.