Utilization Review LVN/RN

Healthcare Support Staffing; Columbus (OH); On-site; USD 65,000 - 85,000; Full time

Job summary

A national healthcare recruiting firm is looking for a candidate with inpatient nursing experience in Columbus, Ohio. You will be responsible for assessing services to ensure optimal outcomes and compliance with regulations, analyzing clinical requests, and conducting prior authorization reviews. The ideal candidate should have 2 years of inpatient nursing, familiarity with Utilization Management, and experience with ICD10 and CPT coding. Interested candidates should reach out to apply.

Qualifications

• 2 years inpatient nursing experience in a hospital environment (Med-Surg, ER).
• Familiarity with Utilization Management protocols required for elective vs urgent requests.
• Experience with provider claims, appeals, and denials processes.
• 6+ months experience with Interqual guidelines.
• 6+ months experience in medical coding (ICD10 and CPT/HCPCS).

Responsibilities

• Assess services for members to ensure optimum outcomes and compliance.
• Analyze clinical service requests against evidence-based guidelines.
• Conduct prior authorization reviews to determine financial responsibility.

Skills

Inpatient nursing experience

Utilization Management expertise

Experience with prior authorization

Coding proficiency with ICD10 and CPT/HCPCS

Clinical analysis skills

Job description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

• Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
• Conducts prior authorization reviews to determine financial responsibility
  

Qualifications

• 2 years Inpatient background with Hospital Nursing (Med-Surg, ER)
• Well versed in Utilization Management-Must be able to determine elective vs urgent request withPrior Authorization Review
  
• Provider Claims, Appeals and Denials -certain services require prior authorization (PA) from theUtilization Management (UM) department
• 6 + months of Interqual experience
• 6+ months of Coding with ICD10 and CPT/ HCPCS

Additional Information

Interested in being considered?

If you are interested in applying to this position, please click the Green I’m Interested Button to email your resume and contact Jeff St Louis 407-478-0332x223.