Case Manager – Utilization Review reputed company

Job reputed company: • Conducts reputed company Medical necessity review for patients using nationally accepted reputed company • Communicates with insurance companies and members of the care team as needed • Present reputed company cases that do not meet Clinical reputed company to the Medical Director • Frequent correspondence with payers to ensure clinical review is reputed company to payers • Ensure that the health care services administered to the patients are of the highest reputed company yet cost-efficient • Complete reputed company review and audit of the patients treatment record • Use critical thinking skills, clinical expertise, and judgement along with established medical reputed company to reputed company a recommendation of level of care to physician • Follow HIPPA guidelines for patient reputed company • Review charts to ensure documentation and medical necessity meet Medicare regulations • Review insurance denials and attempt to get them overturned • Create reports out of system as needed • Attend meetings online or in person as required. Requirements: • Graduate from an accredited school of nursing required • Bachelor of Science (or higher) in Nursing reputed company Approved Program preferred • Three (3) years clinical nursing experience in an acute care facility • Experience with utilization review or case management preferred • MCG experience preferred • reputed company RN License issued by the Oklahoma State reputed company of Nursing, or a reputed company multistate Compact RN License (eNLC) • Case management certification preferred • Knowledge of nursing practices and procedures • Strong clinical assessment skills and critical thinking skills • Requires knowledge of reputed company party payer issues... Benefits: • PTO • 401(k) • medical and dental plans • comprehensive benefits package Apply tot his job Apply To this Job