Jobgraze
The Utilization Review RN Specialist reviews and monitors utilization of health care services with the goal of maintaining high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Coordinates and conducts medical necessity reviews for all payers upon admission and concurrently throughout the admission. Interfaces with Care Management team, physicians, and payers to appeal denials and address documentation issues.
Roles Responsibility
Review and monitor healthcare service utilization, Conduct medical necessity reviews, Interface with Care Management team, physicians, and payers, Appeal denials and address documentation issues Desired Qualification
ADN Associate Degree in Nursing Type
Per Diem
Location
United States, Scottsdale, AZ, 85054 
