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Utilization Review LVN/RN at HealthCare Support Staffing | Columbus

On-site Full-time

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Experience Level

Experience

Qualifications

Minimum of 2 years of inpatient nursing experience in a hospital setting (Med-Surg, ER). Proficient in Utilization Management, with the ability to differentiate between elective and urgent requests as part of the Prior Authorization Review. Experience with provider claims, appeals, and denials; familiarity with services requiring prior authorization from the Utilization Management (UM) department. At least 6 months of experience with Interqual criteria.6+ months of experience in medical coding using ICD-10 and CPT/HCPCS.

About the job

  • Evaluate services provided to members, ensuring optimal outcomes, cost efficiency, and adherence to all state and federal regulations and guidelines.
  • Review clinical service requests from members or providers against evidence-based clinical guidelines to ensure appropriateness.
  • Perform prior authorization reviews to ascertain financial responsibility and manage utilization effectively.

About HealthCare Support Staffing, Inc.

HealthCare Support Staffing, Inc. (HSS) is a nationally recognized leader in healthcare recruitment and staffing. We specialize in connecting talented healthcare professionals with prestigious healthcare facilities, including Fortune 100 health plans, hospitals, medical billing centers, and more. Our strong relationships with top providers ensure that healthcare professionals have quick access to rewarding career opportunities tailored to their expertise. Join us and discover how a conversation with one of our Professional Recruiting Consultants can lead to a fulfilling career!

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