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Nurse Clinician

Company: Mindlance
Location: Chattanooga
Posted on: January 16, 2022

Job Description:

Advance your career with Mindlance! We have been connecting talented IT professionals with world-class companies since 1999. Mindlance is here to help you to find the perfect fit with just the right company. Currently, we are seeking a Nurse Clinician for an exciting career growth opportunity. Make your next big career move with the kind of position that will allow you to be genuinely passionate about the work you do! Our recruiters will work closely with you to help you get the edge over the competition. Let Mindlance advocate for you - apply today! Utilization Review Nurse / Prior Authorization Nurse / Registered Nurse Case Manager Job Duties & Responsibilities: - Performs comprehensive pre-existing reviews, reviews of rider-related diagnoses, potential misrepresentation referrals, rider related drug appeals, provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, nursing judgment, and contractual eligibility. - Performs thorough research and provides complete documentation for rationale to support determinations as well as specific written instructions regarding additional information necessary to complete the review. - Performs or participates in special studies or projects/pilots as directed by departmental management. - Cross functional and accomplished in all ancillary review functions. - May mentor/trains new incumbents and serve as a preceptor. - Seek the advice of the Medical Director when medical judgment is required. - Initiate referrals to accomplish discharge planning when such plans are evident at the time of the request e.g., telephone request for scheduled for total hip replacement. - Assist non-clinical staff in performance of administrative reviews. - Interact with Onsite and Case Management areas to ensure smooth transfer of member information across the continuum of care. - Apply established vendor protocols for authorization processes. - Serves as a presentation guide for walk-through surveyors, auditors, group representatives, etc. Utilization Review Nurse / Prior Authorization Nurse / Registered Nurse Case Manager Job Requirements: "Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."

Keywords: Mindlance, Chattanooga , Nurse Clinician, Healthcare , Chattanooga, Tennessee

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