Medical Review Nurse-RN/LVN-Managed Care

Location: Sacramento, CA
Date Posted: 04-15-2018
Job description
Position Purpose: Perform retrospective review of large hospital and physician claims for admission appropriateness, coding, length of stay, and pricing and review retrospective medical necessity appeals against medical review criteria to make benefit determinations.
 
  • Perform retrospective high dollar claims for benefit and pricing determination
  • Collect hospital medical records as appropriate and work with related hospital staff.
  • Work collaboratively with Finance Department to determine appropriateness of pricing.
  • Assist with other clinical functions of medical review.
  • Maintain appropriate records, files, documentation, etc.
Qualifications:
Education/Experience: Graduate from an Accredited School of Nursing. Bachelor�s degree in Nursing preferred. field. Licensed or Registered Nurse. Advanced degree and/or certification preferred. 2+ years in acute care nursing and utilization review. Knowledge of managed care programs and practices required. 
 
License/Certification: Licensed or Registered Nurse
Very competitive salary and benefits!
Great company to work for!
Full relocation package is available!
Don't miss out! Apply now and we'll be in touch immediately with more specific details, salary information and to answer any questions!!

This position does NOT provide sponsorship so please do NOT apply if you require sponsorship.  Thank You

KP Recruiting Group 
"Bringing Talent to the Marketplace"

KP Recruiting Group is a well established and very respected recruiting firm.  We have built a strong reputation as a premier resource for providing highly qualified candidates for our clients.  We are very experienced in many industries and have a wide range of clients.  We will serve as your advocate during your career search!  Let us do the work for you!  There is never a fee for our services!



 
or
this job portal is powered by CATS