UR Utilization Review/ Chart Review Job in Nashville, Tennessee US
UR Utilization Review/ Chart Review
Kelly Healthcare Resources (KHR) specializes in providing highly skilled nursing and allied health professionals within hospitals and other health care facilities, as well as positions in sectors such as insurance, pharmaceutical, health management, and education. We are currently in search for 6 Medical Reviewers f or our client in Nashville, TN. This is a contract position for 90 days. Job Responsibilities Include: · Performs medical claim reviews for one or more of the following: claims for medically complex services, services that require · Preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, and correct coding for claims/operations. · D ecides on reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines. · Determines medical necessity and appropriateness and/or reasonableness and necessity for coverage and reimbursement. · Documents medical rationale to justify payment or denial of services and/or supplies. Requirements: · 2 years clinical plus 1 year utilization/medical review, quality assurance, or home health, OR 3 years clinical. · Active RN licensure in state OR, active compact multistate RN license · Associate Degree Nursing, OR, 4-year degree in health-related field, OR, Master's in Social Work, Psychology or Counseling In addition to working with the world?s most recognized and trusted name in staffing, Kelly employees can expect: Competitive pay Access to a comprehensive employee benefits package including health, prescription, vision, dental, and life and short-term disability insurance Paid service bonus and holidays Portable 401(k) plans Access to continuing education via the Kelly Learning Center For immediate consideration, click the "Apply Now!" button, or refer a friend by clicking the "E-mail this job" link provided. ?