Offer summary
Qualifications:
RN or MD degree with clinical knowledge and active unrestricted clinical license in at least one state within the United States, Minimum of 5 years recent acute-care hospital experience, preferred. Minimum of 2 years Utilization Review / Case Management experience within the last 5 years..
Key responsabilities:
- Perform retrospective medical necessity reviews to determine appeal eligibility of clinical disputes/denials.
- Construct and document a succinct clinical case supporting appeals using appropriate medical necessity criteria and other pertinent clinical facts.