Utilization Review RN

healthcaresupportstaffing1
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📍 IN📍 Indianapolis📍 Indianapolis, IN, United States📍 usFull time

About this role

Company Description

Why You Should Work For Us:

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

  • Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs, or community resources.
  • Applies clinical knowledge to work with facilities and providers for care coordination.
  • Works with medical directors in interpreting appropriateness of care and accurate claims payment.
  • May also manage appeals for services denied.
  • Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.

Qualifications

  • Must have clear and active RN license in the state of IN
  • AS/BS in Nursing or combination of education / experience
  • 2 years of experience in an acute care clinical environment
  • Strong computer skills/ability to navigate multiple systems (MS Outlook/Word/Excel)

Additional Information

Advantages of this Opportunity:

  • Competitive salary
  • Fun and positive work environment
  • Medical benefits offered

Interested in being considered? 

• Apply now for immediate consideration! You may contact Christine Morta at (407) 233-0769.

Frequently Asked Questions

Is the salary disclosed for the Utilization Review RN position at healthcaresupportstaffing1?
The salary for this Utilization Review RN role at healthcaresupportstaffing1 is not publicly listed. Click "Apply Now" to learn more about the compensation package on their official careers page.
Where is the Utilization Review RN position at healthcaresupportstaffing1 located?
This Utilization Review RN role at healthcaresupportstaffing1 is based in IN, Indianapolis, Indianapolis, IN, United States, us. The position is listed as on-site or hybrid. Check the full job description or apply directly to confirm the work arrangement.
Is the Utilization Review RN role at healthcaresupportstaffing1 full-time or part-time?
This is listed as a Full time position. It is posted as a Utilization Review RN role at healthcaresupportstaffing1.
How do I apply for the Utilization Review RN position at healthcaresupportstaffing1?
Click the "Apply Now" button on this page. You will be redirected to healthcaresupportstaffing1's official application portal hosted on smartrecruiters where you can submit your application directly.
When was the Utilization Review RN job at healthcaresupportstaffing1 posted?
This Utilization Review RN position at healthcaresupportstaffing1 was posted on Mar 23, 2017. Apply as soon as possible — early applications are often reviewed first.
Utilization Review RN
healthcaresupportstaffing1
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