Nurse Quality Analyst - Remote plus $10K Sign on Bonus

Tenet Healthcare; Frisco (TX); Remote; USD 60,000 - 80,000; Full time

Job summary

A healthcare provider in Frisco, Texas is seeking a Registered Nurse to perform medical necessity reviews and support clinical appellate processes. Candidates must possess a valid RN license and have at least 3 years of acute care experience. This position offers competitive pay of up to $46.28 per hour, a comprehensive benefits package, and potential eligibility for a signing bonus. Join a supportive environment focused on improving healthcare services.

Benefits

Comprehensive benefits package including medical, dental, vision, and life insurance

401k plan with up to 6% employer match

Minimum of 12 days of paid time off per year

Qualifications

• Minimum of 3 years of recent acute care experience in a facility environment.
• Knowledge of managed care contracts and reimbursement processes.

Responsibilities

• Perform retrospective medical necessity reviews to assess the appeal potential of clinical disputes and denials.
• Utilize medical necessity criteria to construct and document clinical cases for appeals.

Skills

Critical thinking skills

Excellent written and verbal communication skills

Education

Valid Registered Nurse (RN) license

Job description

Overview

Employer Industry: Healthcare Services

Why consider this job opportunity:

• Salary up to $46.28 per hour
• Potential eligibility for a signing bonus for qualified new hires
• Comprehensive benefits package including medical, dental, vision, and life insurance
• Minimum of 12 days of paid time off per year, with accrual based on hours worked
• 401k plan with up to 6% employer match
• Opportunity to work in a supportive environment focused on improving healthcare services

Responsibilities

• Perform retrospective medical necessity reviews to assess the appeal potential of clinical disputes and denials
• Utilize medical necessity criteria, such as InterQual®, to construct and document clinical cases for appeals
• Follow documented processes to support the clinical appellate process while adhering to productivity and quality goals
• Serve as a resource for non-clinical personnel and assist in process improvement initiatives
• Collaborate with the Law Department on medical necessity reviews and attend mediation hearings as required

Qualifications

• Must possess a valid Registered Nurse (RN) license
• Minimum of 3 years of recent acute care experience in a facility environment
• Critical thinking skills with the ability to make independent decisions regarding medical necessity
• Excellent written and verbal communication skills
• Knowledge of managed care contracts and reimbursement processes

Preferred Qualifications

• Minimum of 2 years of experience in Utilization Review or Case Management
• Experience in medical-surgical or critical care settings
• Previous instruction on InterQual® products (Acute Adult, Pediatrics, Outpatient, and Behavioral Health) preferred
• Familiarity with managed care payer systems and processes

Additional Information

#HealthcareServices #RevenueCycle #Nursing #CareerOpportunity #CompetitivePay #BenefitsPackage

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