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Vantage Search Group
Overview
The Registered Nurse will develop and implement a comprehensive utilization management plan to justify medical necessity and analyze healthcare resource utilization. They will act as a liaison between medical staff and insurance carriers while monitoring specialty care referrals for appropriateness and compliance with regulatory standards.
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Compensation
$40 - $44 / HOUR
Posted
1 month ago
EL PASO CHILDRENS HOSPITAL CORPORATION
The Utilization Review Nurse monitors hospital services to ensure the appropriateness of admissions and extended stays. They collaborate with physician advisers to support policy development and manage clinical denials related to medical necessity.
Salary not listed
St. Joseph's Health
The specialist will perform coding audits to ensure compliance with all federal and state guidelines, including Medicare/Medicaid requirements. Responsibilities also include conducting validation reviews for various quality and compliance indicators and assisting with internal/external coding education and feedback.
$29 - $44 / HOUR
2 months ago
TruHealth
The role involves contracting providers and essential vendors to maintain CMS adequacy and ensuring they meet credentialing requirements for member care. Responsibilities also include educating providers on Health Plan functions and monitoring relationships to maintain network coverage.
The role involves contracting providers and essential vendors to maintain CMS adequacy and ensuring they meet credentialing requirements within current service areas. Responsibilities also include educating providers on Health Plan functions and monitoring relationships to maintain network coverage.
3 months ago
