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Registered Nurse - Denials/Benefit Review(REMOTE)

Long Beach, CA
Excellent permanent position with tremendous benefits!  Jon one of the top health systems in California.  You must reside in CA to be eligible for this position.

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. 

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

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