Registered Nurse Tampa, FL Professional


CLINICAL REVIEW NURSE
WAGE: $32/HR
LOCATION: TAMPA, FL
CONTRACT 1ST SHIFT
The Clinical Denial Utilization Review Nurse responsible for conducting clinical reviews to justify and dispute payer denials.  The role will develop case studies, coordinate with hospital operations and payers to ensure optimal results in denial prevention.  The clinical denial coordinator will oversee quality assurance for clinical denials, including development of protocol and training.
 
Provide clinical argument, using available Medical Records, to justify and dispute payer denials, all levels of appeals included.
 
The Clinical Denial Utilization Review Nurse is responsible for conducting clinical reviews to justify and dispute payer denials. The role will develop case studies, coordinate with hospital operations and payers to ensure optimal results in denial prevention. The clinical denial coordinator will oversee quality assurance for clinical denials, including development of protocol and training. Develop monthly case studies, identifying payer and hospital operational opportunities
Compile reports as requesting by the ROS client and operations, specific to payers, operations and clinical reviews
Participate in performance meetings as requested by ROS client and operations
Develop and conduct quality reviews of all clinical reviews, including training.
 
Key Responsibilities:

Provide clinical argument, using available Medical Records, to justify and dispute payer denials, all levels of appeals included.
Develop monthly case studies, identifying payer and hospital operational opportunities
Compile reports as requesting by the ROS client and operations, specific to payers, operations and clinical reviews
Participate in performance meetings as requested by ROS client and operations
Develop and conduct quality reviews of all clinical reviews, including training.

 
MINIMUM SKILLS:
5 Years Utilization Review or Case Management 
 
CRITICAL SKILLS:
Extensive knowledge in evidence-based protocol – Hospital Case Management
Excellent verbal and written skills
Ability to analyze and present to both leadership and operational teams
Microsoft Office:  Excel, Word, PowerPoint
 
EDUCATION:
Bachelor of Science in Nursing or Utilization or Case Management
Current valid State of Florida or multi state license as a Registered Nurse
 
Please email resume to nikki@careerpros.com
 
Sedona Staffing Services is an Equal Opportunity Employer
 
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(563) 556-3040

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