Nurse Clinician

A Nurse Clinician job in Chattanooga TN is available courtesy of Adecco Medical & Science. We are in search of a candidate that has acute hospital experience, especially in the ICU or emergency room.

Nurse Clinician job responsibilities include:

Performs comprehensive pre-existing reviews, reviews of rider-related diagnoses, potential misrepresentation referrals, rider related drug appeals, provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, nursing judgement, and contractual eligibility
Performs or participates in special studies or projects/pilots as directed by departmental management. • Cross functional and accomplished in all ancillary review functions. • May mentor/trains new incumbents and serve as a preceptor
nteract with Onsite and Case Management areas to ensure smooth transfer of member information across the continuum of care.


QUALIFICATIONS:

Registered Nurse in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law required
Minimum three years’ clinical experience required
Proficient knowledge and ability to apply various accreditation requirements (URAC, NCQA, etc.) preferred
Proficient in interpreting benefits, contract language specifically symptom-driven, treatment driven, look back periods, rider information and medical policy/medical review criteria preferred

If you are interested in this Nurse Clinician job in Chattanooga TN then please click APPLY NOW. For other opportunities available at Adecco Medical and Science go to www.adeccousa.com.

If you have questions about the position or would like more information please contact Hari at 585-613-3037.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

  • Apply with Adecco

Reference number US_EN_2_101083_334196