Position Summary
The RN Appeal Administrator will be responsible for the Pre-denial/ Denial and appeal process in addition to Utilization Review, to validate the patient’s placement to be at the most appropriate level of care based on nationally accepted admission criteria. The Appeal/ UR Administrator uses medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures and an estimation of the patient’s expected length of stay. The The Appeal/ UR Administrator secures authorization for the patient’s clinical services through timely collaboration and communication with payers as required. The Appeal/ UR Administrator follows the UR process, in addition to the pre-denial and denial/appeal process as defined in the attached job description and in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review. Position: Registered Nurse Department: Denial/Appeal Administrator Schedule: Monday- Friday, evenings, 40 hours, 4p-12:30a Education JOB REQUIREMENTS...Anticipated hourly range: $20.08 per hour - $21.40 per hour based on experience (includes shift differential). Benefits: Paid time off in... ...in the facility includes order picker (cherry picker), forklift, reach truck, turret truck, pallet jack, and walkie rider....
...Looking for someone who can learn quickly and show up to work every day. They are looking to hire someone on permanently. MUST PASS A DRUG TEST (NO THC) AND A BACKGROUND CHECK Chesapeake-Suffolk, VA 3180 730 High Street Suite B Portsmouth, VA 23704
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