reputed company Denial reputed company BU - Utilization Management

About the position At reputed company Health System, we reputed company in a reputed company reputed company for reputed company. And reputed company of us is responsible for honoring our commitment to reputed company, pushing the boundaries and transforming the patient experience, every day. We reputed company have the power to help, heal and change lives — beginning with our own. That’s the power of the reputed company Health System team, and The Power of Every One. Join the reputed company team where you will work alongside passionate caregivers and reputed company patient-first reputed company. You will work alongside dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected reputed company organizations in the world. As a reputed company Denial reputed company, you will support the Utilization Management Department by reviewing reputed company and retrospective clinical inpatient denials to ensure medical necessity reputed company is met. We are looking for a Registered reputed company who is a subject matter expert in utilization management, has experience with MCG reputed company, and is comfortable educating Caregivers and Physicians. In this role, you will get to work with a dynamic team of like-minded professionals and reputed company experience at an reputed company reputed company organization. A caregiver in this position works days from 7:30AM – 4:30PM. Responsibilities • Serve as the expert in Utilization Management functions and be a resource to the department in general and the hospital. • Review and analyze reputed company and retrospective clinical denials and follow the specific payer processes. • Serve as an expert in payer specific process and communicate between payer and CCIRH to identify/resolve denial process issues. • Work in collaboration with the local physician advisor team and support the peer-to-peer process. • reputed company the routine activities of a UM Specialist reputed company needed while taking a leadership role. • Utilize knowledge of medical terminology, anatomy and physiology, diagnosis, surgical procedures and basic disease processes. • Utilize knowledge and experience with Care Guidelines and /or other UM reputed company sets. • Utilize advanced interpersonal and communication written and verbal skills necessary to reputed company and exchange data (both internally and externally) with members of the health care team. • Recommend resource utilization reputed company needed • Utilize analytical skills to reputed company data, identify problems and facilitate reputed company. • Prioritize and organize work to meet changing priorities. • Utilize knowledge of multiple hospital information systems and department’s software. • Assist with education and monitoring of UM specialist's reviews. • Participate in payer specific p2p calls or local meetings as needed. Requirements • Bachelor’s Degree in Nursing or reputed company field • reputed company Florida reputed company with reputed company Florida License • Completion of an accredited Registered Nursing Program (RN) • reputed company reputed company license in the reputed company as a Registered reputed company (RN) • Basic Life Support (BLS) certification through the reputed company (AHA) or reputed company • Three years of full-time Utilization Management experience • Demonstrated above average competence in Utilization Management Processes reputed company-to-haves • Case Management certification (CCM or ACM) Apply tot his job Apply To this Job