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Utilization Review Nurse/Case Manager in Racine, WI at Pride Health

Date Posted: 5/20/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Racine, WI
  • Experience:
    Not Specified
  • Date Posted:
    5/20/2019

Job Description

PRIDE Health has an opportunity for a Utilization Review RN to work within a respected health care facility in Racine, WI.

Job Duties:

  • Responsible for reviewing medical records and prepare clinical appeals (when appropriate) on medical necessity, level of care, length of stay, and authorization denials for hospitalized patients
  • Demonstrate understanding of the severity of an array illnesses, intensity of service, and care coordination needs are key, as the nurse must integrate clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient
  • Manages all activities related to the monitoring, interpreting, and appealing of clinical denials received from third-party payers and ensures accuracy in patient billing.

Qualifications:

  • Must have Active Registered Nurse License in WI or compact state.
  • Must have ER/Behavioral Health Experience
  • At least 2 years of experience

Please apply here or send your resume directly to april.foster@pride-health.com

IndhcApr2019