Medasource
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Position: Utilization Review Nurse Auditor
Location: 100% Remote
Duration: 3-month contract
Start Date: ASAP
Job Description:
The R1 Physician Advisory Team offers a range of services that help navigate the path to compliant revenue. The Payor Peer to Peer team reviews cases for which the authorization has been denied evaluating if the proper documentation was available to support the admission status, procedure, and care setting that was requested. The Nurse Author in Payor Peer to Peer advises our clients regarding the appropriateness of the request based on available documentation. Our goal is to assist our client facilities in ensuring proper billing and authorization level; thereby increasing clean claims submission and reducing accounts receivable days. This team can also serve as a clinical resource to medical and case management staff by providing identification, facilitation, and resolution of documentation and utilization issues.
Responsibilities:
- Writing client-facing clinical reviews evaluating the authorization requested, documentation support or lack of support for that authorization, evidenced based criteria for that support, and complex clinical evaluation of the request as a whole
- Evaluation and interpretation of multiple types of hospital documentation as it relates to the requested authorization, including but not limited to emergency department documentation, history and physical, progress notes, interpretation of lab and imaging results, vital sign trends, physical and occupational therapy notes, and medication administration records
- Provide strength evaluation and recommendations to clients using a combination of understanding of commercially available criteria and clinical judgement for establishing medical necessity arguments in the setting of concurrent denials
- Nurses should be highly capable of working independently with a high level of performance in in a rapidly changing, fast paced environment.
- Successful nurses will meet or exceed minimum productivity and quality standards.
- Provide feedback regarding actionable root cause analysis of the specific cases to customer utilization review team and/or case managers regarding submitted case determinations.
- Provide written analysis of the case and perform case reviews across multiple specialties
Minimum Qualifications:
- Active, current registered nurse license in at least one US state
- At least 3 years of acute, hospital-based clinical experience in a medical/surgical unit, emergency department, and/or ICU
- Must have some flexibility with schedule
- Home office that is HIPAA compliant
- BSN preferred
Desired Qualifications:
- Basic knowledge/prior experience with InterQual and/or Millman/MCG criteria a plus
- Prior utilization management experience preferred
UR Nurse Auditor Chicago, IL
For over 16 years, Medasource has established and maintained relationships that are designed to meet your IT staffing needs. Whether it’s contract, contract-to-hire, or permanent placement work, we customise our search based upon your company’s unique initiatives, culture and technologies. With our national team of recruiters placed at 21 major hubs around the nation Medasource finds the people best-suited for your business. When you work with us, we work with you. That’s the Medasource promise.
Medasource is an equal opportunity employer that does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, lactation and related medical conditions), gender identity or gender expression, sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances.
Benefits & Perks:
Medasource offers competitive medical, dental, vision, Health Savings Account, Dependent Care FSA, and supplemental coverage with plans that can fit each employee’s needs. We offer a 401k plan that includes a company match and is fully vested after you become eligible, paid time off, sick time, and paid company holidays. We also offer an Employee Assistance Program (EAP) that provides services like virtual counseling, financial services, legal services, life coaching, etc.
Pay Disclaimer:
The pay range for this job level is a general guideline only and not a guarantee of compensation or salary. Additional factors considered in extending an offer include (but are not limited to) responsibilities of the job, education, experience, knowledge, skills, and abilities, as well as internal equity, alignment with market data, applicable bargaining agreement (if any), or other law.
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