Nurse Consultant - Topeka
3 weeks ago

Job summary
This job is responsible for the day-to-day operations of reviewing and processing predeterminations,claims, appeals, and other inquiries utilizing independent decision making in accordance with medical policy,
standards of medical practice, and within contractual benefits.
Responsibilities
- Responsible for independent timely resolution of predeterminations,
claims, and appeals utilizing medical policy/Interqual criteria
and/or physician consultant recommendations as needed. - Responsible for responding to inquiries regarding medical necessity,
correct coding, allowances, audits/CSC requests,
Job description
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