Supervisor, Care Coordination Department/Utilization Review Nurse - Hamilton
2 weeks ago
Job summary
The Utilization Review Nurse is responsible for performing daily utilization review activities, including concurrent and retrospective reviews using evidence-based criteria to ensure timely authorization for inpatient, outpatient and observation services with payers.They must communicate clinical information to insurers and regulatory agencies to secure and maintain coverage.
- Collaborate with physicians, nursing staff and ancillary departments to ensure documentation supports medical necessity.
- Monitor and track denials, initiate appeals and assist in denial prevention strategies.
Job description
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