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21 Jul
Registered Nurse - Denials/Benefit Review(Permanent)

Vacancy expired!

Excellent permanent position with tremendous benefits! Jon one of the top health systems in California.

About us:

Morgan Stephens represents the nation’s top healthcare systems offering the highest compensation and benefits to our top candidates. We are created and managed by experienced industry professionals in healthcare. Asa leading provider of contract, contract to perm, and direct placement recruiting services to healthcare organizations throughout the United States, we have successfully served the needs of our employees and clients by placing thousands of quality healthcare professionals into organizations seeking top talent.

Open Position:

The position is responsible for supporting specific utilization management functions within the department. These functions include review of SNF stays for authorization of admissions, continued stay reviews for appropriate level of care, and effective discharge planning. Review of high dollar inpatient cases for reinsurance activity. Review and authorization, including reporting, for transplant requests and services, and collaboration with Contracting for single case agreements.


Review SNF requests to determine if needed information has been provided and request additional information as needed

Approve or deny SNF admission according to established criteria

Assign a date for the next required continued stay review

Process and manage transplant requests according to regulatory requirements and department protocol

Complete reporting requirements for transplant services

Review request continued stay reviews

Submit questionable service requests toMedical Director along with recommendation

Issue denial notices based on established unit protocols and state and/or federal requirements

Review Medcial/Surgical inpatient stays for reinsurance clinical reporting

Complete all required documentation and reporting requirements for activities

Essential Department and Organizational Functions

Process service requests and complete reviews and documentation according to established timelines, including claim issues, reinsurance reporting, and transplant management.

Provide training to new employees on specific tasks related to their job responsibilities

Follow established departmental policies and procedures

Report to work as scheduled

Perform other duties and projects as assigned, including review of Inpatient High Dollar cases for re-insurance reporting as assigned by Supervisor

Knowledge, Skills and Abilities Required

Knowledge of the Medicare A and B benefit packages

Knowledge of Skilled Nursing Facility criteria

Knowledge of reinsurance reporting requirements

Knowledge of rules for Medicare

Ability to use review criteria

Knowledge of MAP rules and regulations as it pertains to utilization management

Knowledge of ICD-9, CPT and HCPCS codes

Ability to provide critical attention to detail for accuracy and timeliness of processing requests

Ability to complete accurate and timely documentation and reporting

Ability to organize work and remain focused under stressful conditions

Ability to collaborate with community providers including facility staff

Familiarity with the principles of managed care and utilization management

Ability to use critical thinking skills in problem solving

Ability to write and verbally communicate effectively

Excellent customer service skills

Ability to work in an environment with diverse individuals and groups

Ability to manage multiple tasks

Ability to work autonomously

Basic word processing skills

For More Information:

Morgan Stephens ofrecemos reclutadores que hablan Espanol

Vacancy expired!

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