RN Utilization Review - Patient & Family Services - Per Diem

Come work at the best place to give and receive care! ​Job Description: This Role is On-Site Who We Are: Southern NH Medical Centers strives to keep patients on a continuous track to discharge and receive the continuity of care that our patients and their families need

Our Patient and Family Services Department is the driving force to assure communication, respect, and safety follows our patients throughout the admission phase, all the way through the discharge process

This department includes a dedicated team of Case Managers, Social Workers, and Interpreters that ensure that all care is equal, and our patients dignity is maintained above all else.

About the Job

• The Utilization Review/Denial Specialist works with the care team to evaluate medical acuity for the appropriate level of care orders and documentation to facilitate insurance coverage, and proactively prevent denials. This specialist ensures level of care charges are applied accurately and meet compliance with CMS and commercial insurance guidelines as well as reviewing appeal options for medical necessity insurance denials What You’ll Do: Assess acute medical necessity utilizing appropriate criteria. Collect and trend Utilization Review data metrics. Review appeal options for commercial insurance, RAC, and QIO medical necessity denials. Understand and apply CMS Regulations to meet compliance Who You Are: Current NH Nursing License as a Registered Nurse. ASN accepted; BSN required within 10 years of hire. A minimum of 5-years of experience as a Registered Nurse.
• Experience in use of Interqual, Milliman or other Healthcare acute criteria preferred. Why You’ll Love Us: Health, dental, prescription, and vision coverage for full-time & part-time employees Short-term, long-term disability, life & pet insurance Student Loan Forgiveness & Discounts 403(b) Retirement savings plans Continuous earned time accrual & So much more! Work Shift: Per diem weekends and holiday. Other days available if staff have availability. SolutionHealth is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law.