Nurse Consultant

  • Location
    Chattanooga , Tennessee
  • Category
    Medical & Science - Nursing
  • Job type

A Nurse Consultant job in Chattanooga TN, is available through Adecco Medical and Science. Performs comprehensive pre-existing reviews and makes clinical determinations of pre-existing or not pre-existing status based on medical judgment and contractual eligibility of the services provided. The comprehensive review includes review of related claims and customer service documentation, and review and interpretation of all medical records. Performs these reviews in a timely manner meeting departmental and corporate turnaround requirements.

Nurse Consultant job responsibilities:

• Performs thorough research and provides complete documentation for rationale to support both determinations of pre-existing and not pre-existing, as well as specific written instructions regarding additional information necessary to complete the review.
• In addition to initial pre-existing reviews, performs review of rider-related diagnoses, potential misrepresentation referrals, provider and member appeals, and rider-related drug appeals
• Seeks the advice of the Utilization Management Medical Director as appropriate
• Proficient in interpreting benefits, contract language specifically symptom-driven, treatment-driven, look-back periods, and rider information, and medical policy language

• Must have active registered nurse license 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
• Minimum of at least 5 years of clinical experience
• Must possess excellent verbal and written communication skills with problem solving abilities, organizational, leadership, and interpersonal skills. • Ability to work independently and handle multiple tasks.
• Must be PC literate and experience in Windows and Microsoft Office is preferred

If you are interested in this Nurse Consultant position in Chattanooga TN, then please click APPLY NOW. For other opportunities available at Adecco Medical and Science go to If you have questions about the position, please contact Hari Dhurjaty at 585-613-3037 or
Equal Opportunity Employer Minorities/Women/Veterans/Disabled

  • Apply with Adecco

Reference number US_EN_2_101083_313560