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Nurse Reviewer

A-Line Staffing Solutions

This is a Full-time position in Atlanta, GA posted November 20, 2021.

Concurrent Review Nurse RN openings with a major health insurance / managed care company in the Atlanta, GA 30339! Starting ASAP!! Apply now with Luke H. at A-Line!

**Position will be remote to start but will return in office hoping by Fall of 2021 – Must live near Atlanta, GA 30339**

Job Summary: This request is for our Adult Med/Surg  and Post- Acute (SNF, Rehab) membership

Requirements:

  • Must have 2-4 years On-site Concurrent Review Experience
  • Must have an active license in the State of Georgia as an RN
  • Graduate from an Accredited School of Nursing for either Vocational Nursing or RN’s.
  • Need proficient Computer skills, and to be able to read and review medical records; Digital focused is a must

Preferred Skills:

  • Knowledge of healthcare and managed care
  • Hospital or previous insurance company
  • Associate’s or Bachelor’s degree in Nursing highly preferred.

Pay: $35.00 to $42.00 per hour (determined on experience)

Work Schedule: Monday – Friday 40 hours/week from 8am-5pm or 9am-6pm

Job Description:

  • Perform onsite/telephonic review of emergent/urgent, and continued stay requests for the appropriate level of care and setting following medical necessity guidelines, UM policy and procedures.
  • RN with previous hospital UM or NICU experience. Previous employment with a managed care company. Experience with electronic medical record systems and computer documentation. Time management and good communication skills.
  • Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
  • Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
  • Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care
  • Conduct discharge planning
  • Educate providers on utilization and medical management processes
  • Provide clinical knowledge and act as a clinical resource to non-clinical team staff
  • Enter and maintain pertinent clinical information in various medical management systems

Why Apply with A-Line:

  • Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
  • 401k after 1 year of employment: With employer match and profit sharing
  • GREAT Hours! Monday through Friday, 40 hours per week
  • Competitive Pay Rate

Keywords: Concurrent Review, Utilization Review, URAC, Utilization Management, UM, UR, Retrospective Review, Prior Authorization Nurse, PA Nurse, Medicare, Medicare Review, CMS, Medicaid, BSN, ASN, ADN, MSN, Case Management, URAC, Authorization Nurse, Intake Coordination, Discharge Planning, Utilization Management, Utilization Review, Home Healthcare, Medical Billing, Medical Coding, Provider Services, Member Services, CMS, Managed Care, MCO, Benefit Verification, LVN, Licensed Vocational Nurse, Clinical Care, Clinical Service, Clinical Coordinator, Nurse, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Reimbursement Counselor, Medical Customer Service, Healthcare, Inbound Calls, Outbound Calls, Medicare, Medicaid, CCM, InterQual, ICD-10, URAC, CMS, Medicare, Medicaid, Case Management, Certified Case Manager, Medical Coding, BSN, Medical Management, Utilization Review, Utilization Management, Registered Nurse, MCO, RN, Nurse, Managed Care, Medical Claims, Appeals, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Patient Counselor, Healthcare, Inbound Calls, Outbound Calls.

Job Requirements:

Requirements:

  • Must have 2-4 years On-site Concurrent Review Experience
  • Must have an active license in the State of Georgia as an RN
  • Graduate from an Accredited School of Nursing for either Vocational Nursing or RN’s.
  • Need proficient Computer skills, and to be able to read and review medical records; Digital focused is a must

Preferred Skills:

  • Knowledge of healthcare and managed care
  • Hospital or previous insurance company
  • Associate’s or Bachelor’s degree in Nursing highly preferred.

Keywords: Concurrent Review, Utilization Review, URAC, Utilization Management, UM, UR, Retrospective Review, Prior Authorization Nurse, PA Nurse, Medicare, Medicare Review, CMS, Medicaid, BSN, ASN, ADN, MSN, Case Management, URAC, Authorization Nurse, Intake Coordination, Discharge Planning, Utilization Management, Utilization Review, Home Healthcare, Medical Billing, Medical Coding, Provider Services, Member Services, CMS, Managed Care, MCO, Benefit Verification, LVN, Licensed Vocational Nurse, Clinical Care, Clinical Service, Clinical Coordinator, Nurse, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Reimbursement Counselor, Medical Customer Service, Healthcare, Inbound Calls, Outbound Calls, Medicare, Medicaid, CCM, InterQual, ICD-10, URAC, CMS, Medicare, Medicaid, Case Management, Certified Case Manager, Medical Coding, BSN, Medical Management, Utilization Review, Utilization Management, Registered Nurse, MCO, RN, Nurse, Managed Care, Medical Claims, Appeals, Mail Order Medications, Insurance Verification, Pharmacy, Prior Authorization, Patient Counselor, Healthcare, Inbound Calls, Outbound Calls.


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