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RN - Reviewer Contract Compliance - FT - Days - Memorial Support Services
Complete appeal documents to address managed care denials and ensure compliance with regulations.
Miramar, Florida, United States
Mid-Level
1 month ago
Memorial Regional Hospital
Memorial Regional Hospital is a leading healthcare provider in Hollywood, Florida, offering comprehensive medical services.
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✨ About The Role
- The RN - Reviewer Contract Compliance role involves completing appeal documents based on medical necessity and appropriateness of services.
- The position requires participation in meetings with clinical personnel from managed care companies to address unresolved cases.
- The RN will assist with questions related to denials or underpayments concerning readmissions, coding, and accuracy of charges.
- The role includes reviewing medical documentation and formulating written documents to support overturning denials.
- The RN will communicate directly with managed care payors and internal departments to provide additional information for denial evaluations.
âš¡ Requirements
- The ideal candidate will have a minimum of 3 years of clinical nursing experience in a hospital setting or a clinical area of an insurance company.
- Strong critical thinking skills and the ability to make decisions with minimal supervision are essential for success in this role.
- Effective communication skills are necessary to interact with clinical personnel and managed care companies.
- A solid understanding of managed care and contract terminology will be beneficial.
- The candidate should be proficient in using InterQual and MCG Guidelines to evaluate the necessity of medical services.
RN - Reviewer Contract Compliance - FT - Days - Memorial Support Services
Miramar, Florida, United States
Registered Nurse
About Memorial Regional Hospital
Memorial Regional Hospital is a leading healthcare provider in Hollywood, Florida, offering comprehensive medical services.