Industry: Healthcare Facility

Why consider this job opportunity:
- Competitive pay and bonus opportunities
- Job benefits including healthcare coverage and retirement plans
- Opportunities for career advancement within the organization
- Positive work environment and supportive team
- Continuous opportunities for professional growth and learning

What to Expect (Job Responsibilities):
- Conduct admission and concurrent reviews to ensure compliance with reimbursement policies
- Analyze patient records to determine legitimacy of admission, treatment, and length of stay
- Identify opportunities for workflow improvements and implement necessary changes
- Collaborate with insurance companies and accrediting agencies to ensure compliance with standards
- Prepare and submit appeals for denied accounts

What is Required (Qualifications):
- Licensed Registered Nurse within the state of residence
- Minimum of 5 years of clinical nursing experience in an acute care setting
- 5-7 years of experience in case management, discharge planning, and/or utilization review preferred
- Knowledge of regulatory and payer requirements for Case Management Activities
- Ability to critically evaluate and make decisions for difficult cases
- Proficiency in reading and abstracting information from handwritten medical records
- Excellent oral and technical writing and typing skills
- Flexibility and adaptability to changing priorities and regulations
- Ability to work independently while maintaining confidentiality according to HIPAA regulations

How to Stand Out (Preferred Qualifications):
- Advanced certifications in case management or utilization review
- Experience in resolving denial trends and implementing workflow improvements
- Familiarity with clinical evidence and regulatory arguments for appeals

#UtilizationReviewSpecialist #Healthcare #CaseManagement #RegisteredNurse #HIPAA

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