S'INSCRIRE
Retour aux emplois
XX
Nurse Case Manager CFHP PRNUniversity Health • Pleasanton, California, United States
Trouver des emplois similaires

Cette offre d'emploi n'est plus disponible

XX

Nurse Case Manager CFHP PRN

University Health
  • US
    Pleasanton, California, United States
  • US
    Pleasanton, California, United States
Trouver des emplois similaires

À propos

POSITION SUMMARY AND RESPONSIBILITIES Conducts comprehensive clinical reviews of adverse determinations related to medical necessity. Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making.
Provides support for claim appeals in relation to medical necessity.
Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards.
Facilitates member second level appeal process.
EDUCATION/EXPERIENCE Graduate from an accredited school of professional nursing is required.
BSN preferred.
Minimum 2 years acute care experience or managed care experience is required.
Basic knowledge of Medicaid, Medicare preferred.
Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.
LICENSURE Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.
Active Certification in Case Management (CCM) is preferred.
  • Pleasanton, California, United States

Compétences linguistiques

  • English
Avis aux utilisateurs

Cette offre a été publiée par l’un de nos partenaires. Vous pouvez consulter l’offre originale ici.

Trouver des emplois similaires