BHS Network TX
Nurse Quality Analyst - Remote
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Job Description
- Req#: 88603974880
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Salary up to $46.28 per hour
- Potential eligibility for a signing bonus for qualified new hires
- Competitive benefits package including medical, dental, vision, disability, and life insurance
- Generous paid time off policy with a minimum of 12 days per year
- 401k plan with up to 6% employer match
- Opportunity to work in a supportive environment focused on improving healthcare services
What to Expect (Job Responsibilities):
- Conduct retrospective medical necessity reviews to assess the potential for clinical appeals
- Utilize medical necessity criteria sets, such as InterQual®, to document clinical cases for appeals
- Ensure compliance with departmental productivity and quality standards while working on assigned accounts
- Serve as a resource for non-clinical personnel and assist in developing policies and procedures
- Collaborate with the Law Department on medical necessity reviews and attend mediation hearings as needed
What is Required (Qualifications):
- Must possess a valid nursing license (Registered Nurse)
- Minimum of 3 years recent acute care experience in a facility environment
- Basic knowledge of patient accounting, including UB92/UB04 and EOB components
- Minimum of 2 years experience in Utilization Review or Case Management preferred
- Ability to perform critical thinking and make independent decisions regarding medical necessity
How to Stand Out (Preferred Qualifications):
- Medical-surgical or critical care experience preferred
- Managed care payer experience in Utilization Review, Case Management, or Appeals
- Previous classroom-led instruction on InterQual® products preferred
- Certification as a Case Manager (CCM) or in Utilization Review/Management preferred
#HealthcareServices #RevenueCycleManagement #ClinicalAppeals #NursingJobs #CareerOpportunity
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