Registered Nurse-Review Analys

Perform prospective, concurrent and retrospective review of inpatient services to ensure medical necessity, appropriate length of stay, intensity of service and level of care, including appeal requests initiated by providers, facilities and members. Responsible for the review of precertification, admissions approvals, telephone triage, and/or benefit interpretation. May be required to enter or reference data via PC. Other related skills may be required to perform this job. The maximum hourly rate reflects budget estimates only and does not reflect the final negotiated rate. Bachelor’s degree in nursing, allied health, business, or related field preferred. Two (2) to four (4) years of clinical experience which may include acute patient care, discharge planning, case management, and utilization review with another insurance provider, etc. Demonstrates clinical knowledge and experience relative to patient care and health care delivery processes. One (1) year health insurance plan experience or managed care environment highly preferred. Registered Nurse with current unrestricted Registered Nurse license required.