Registered Nurses for Clinical Appeals Writer

Qualifications:

At least 1 year Clinical (bedside) experienceAt least a year revenue cycle management experiencewith background in Clinical Appeals, InterQual Reviews and MCGWilling to work onsiteWilling to work in BGCShift: 6:00AM-3:00PM

Responsibilities and Duties

Performs retrospective (post-discharge/ post-service) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review.Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate module of InterQual® criteria (Acute, Procedures, etc). If clinical review does not meet IQ criteria, other pertinent clinical facts are utilized to support the appeal. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization.Demonstrates ability to critically think, problem solve and make independent decisions supporting the clinical appellate process.Demonstrates proficiency in use of medical necessity criteria sets,MCG and InterQual®, as evidenced by Inter-rater reliability studies and other QA audits.

Why join us?

 Job Types: Full-time, Permanent Plus, Allowances and 15%-night differentialHMO upon hire plus 1 dependent Additional 2 HMO dependents upon regularization Group life insuranceCOVID-19 considerations: work set up