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Utilization Review_Denial Specialist RN - Nashua, NH - Permanent / Full Time - Staff - Days

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Title: Utilization Review/Denial Specialist RN
Location: Nashua, NH
Employment: Permanent / Full Time
Status: Open
Date Posted: one year agoone year ago
Confirmed Open: 18 hours ago
Employer Name: Southern New Hampshire Medical Center
Start Date: Tue, Nov 21, 2017
Shift: Days
Hours: Open
Contact: Contact employer directly
Details:

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.

Summary:

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.

Qualifications: *

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.

Industry: Healthcare

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Time From To Job Text
6/19/17 8:45 AM
Updated (5 months ago)
SystemSystem1552002Status: Closed
Specialty: Utilization Review - Appeals RN
Location: Nashua, NH
Employment Type: Permanent / Full Time
This job has been closed.
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9/15/16 8:52 AM
Updated (1 years ago)
SystemSystem1552002Status: Closed
Specialty: Utilization Review - Appeals RN
Location: Nashua, NH
Employment Type: Permanent / Full Time
This job has been closed.
Reply  

8/16/16 4:42 AM
Updated (1 years ago)
SystemSystem1552002Status: New
Specialty: Utilization Review - Appeals RN
Location: Nashua, NH
Employment Type: Permanent / Full Time
New job was posted by system.
Reply  

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