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RN - Medical Reviewer Job Details

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Company:  Nurse Resolutions
Job Code:  807-71229
Categories:  Skilled Nursing / Nursing Home (SNF)
Region/Province:  Mississippi (MS)
Job Description: 
The Medical Review Nurse is responsible for the thorough review of claims and medical information to determine the medical necessity of services according to the specific contract provisions and medical policy guidelines. This position is accountable for using established medical criteria to determine if hospital admissions and other outpatient services are medically necessary.   This position follows cases through the continued stay review process: determining medical necessity of continued stay and appropriateness of setting, evaluating and performing discharge planning and identifying patients requiring long term case management. This position is also responsible for identifying alternative levels of care and coordinating such care.
 
Job-Specific Requirements:
·            RN licensure that is unrestricted in the state of Mississippi.
·            Mental health credentialing experience is required.
·            Appropriate continuous education as required by the appropriate licensing board to maintain current licensure.
·            Minimum of 3 years clinical practice experience.
·            Background in Utilization Review or quality assurance in the health care field is preferred.
·            Previous home health experience is preferred.
·            Basic knowledge of Microsoft Office.

CONTACT:
Jason Edwards
Jason@NurseResolutions.com
888.411.2228 x 200 - Phone
407.982.7508 - Fax


Post Date:  04/26/2011
 

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