RN Utilization & Denials Specialist

Covenant HealthCare; Saginaw (MI); Sur place; USD 70 000 - 110 000; Plein temps

Avantages offerts par ce poste

Medical, dental, vision coverage

Retirement plan with employer match

Paid time off

Résumé du poste

Covenant HealthCare seeks an experienced Utilization Management Specialist to ensure appropriate care levels and optimal reimbursement. You will review medical necessity, monitor stay appropriateness, and coordinate with physicians and payors to secure timely authorizations.

Ideal candidates hold an RN license for Michigan, with 3+ years in utilization management, and demonstrate strong communication and negotiation skills.

Qualifications

• RN with Michigan license required.
• 3 years in utilization management (preferred).
• Strong communication and negotiation skills.

Responsabilités

• Perform medical necessity reviews for all inpatients and applicable settings.
• Conduct continuous stay reviews per InterQual guidelines and payor requirements.
• Collaborate with physicians, case management, and payers to secure appropriate authorization for days of care.
• Negotiate with payers and assist with denials management and appeals.
• Maintain documentation and provide reports on utilization metrics.

Connaissances

Customer service

Utilization management

Denial/appeals management

Communication

Negotiation

Teamwork

Formation

RN license (Michigan)

Outils

Epic

InterQual

Description du poste

Covenant HealthCare seeks an experienced Utilization Management Specialist to ensure appropriate care levels and optimal reimbursement. You will review medical necessity, monitor stay appropriateness, and coordinate with physicians and payors to secure timely authorizations.

Ideal candidates hold an RN license for Michigan, with 3+ years in utilization management, and demonstrate strong communication and negotiation skills.