RN Case Manager, Denials Specialist (32 hrs) Remote
Job SummaryThe Denials Specialist (Case Manager) will be responsible for:Utilization Management Case Manager with a focus on managing Clinical Denials and Appeals for inpatient stays.Skills required include the ability to complete Utilization Management Clinical Medical Necessity Reviews for primarily pediatric population. Familiarity with InterQual or another evidence based decision support tool preferred. Position includes providing clinical assessment support for prior authorizations, hospital admissions, and continued inpatient stays, assessing for appropriateness of level of care and duration of treatment plan, in accordance with established procedures, guidelines and criteria.
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