Registered Nurse - Denials/Benefit Review(Permanent)
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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. As a 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. JOB RESPONSIBILITIES: 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: Visit www.morganstephens.com Twitter: www.twitter.com/morganstephens0 Instagram: www.instagram.com/morganstephens0/ Facebook: www.facebook.com/MorganStephens0 Email: info@morganstephens.com Morgan Stephens ofrecemos reclutadores que hablan Espanol |
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