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RN Utilization Review - Patient & Family Services - Per Diem

Location Nashua, New Hampshire
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Job ID
JR11907
Category
Nursing, RNs & LPNs

This Role is On-Site

Who We Are:

Southern NH Medical Centers strives to keep patients on a continuous track to discharge and receive the continuity of care that our patients and their families need. Our Patient and Family Services Department is the driving force to assure communication, respect, and safety follows our patients throughout the admission phase, all the way through the discharge process. This department includes a dedicated team of Case Managers, Social Workers, and Interpreters that ensure that all care is equal, and our patient's dignity is maintained above all else.

About the Job:

The Utilization Review/Denial Specialist works with the care team to evaluate medical acuity for the appropriate level of care orders and documentation to facilitate insurance coverage, and proactively prevent denials. This specialist ensures level of care charges are applied accurately and meet compliance with CMS and commercial insurance guidelines as well as reviewing appeal options for medical necessity insurance denials

What You’ll Do:

  • Assess acute medical necessity utilizing appropriate criteria.
  • Collect and trend Utilization Review data metrics.
  • Review appeal options for commercial insurance, RAC, and QIO medical necessity denials.
  • Understand and apply CMS Regulations to meet compliance

Who You Are:

  • Current NH Nursing License as a Registered Nurse.
    • ASN accepted; BSN required within 10 years of hire.
  • A minimum of 5-years' of experience as a Registered Nurse.
  • Experience in use of Interqual, Milliman or other Healthcare acute criteria preferred.

Why You’ll Love Us:

  • Health, dental, prescription, and vision coverage for full-time & part-time employees
  • Short-term, long-term disability, life & pet insurance
  • Student Loan Forgiveness & Discounts
  • 403(b) Retirement savings plans
  • Continuous earned time accrual

& So much more!

Southern New Hampshire Health is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law.

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  • Medical professional using a stethoscope to listen to a child.

    Magnet Designated Hospital

    Physicians and advance practice providers in primary, specialty and immediate care. Our guiding philosophy is to treat our patients and each other with respect, honesty and compassion.

  • New Hampshire town with fall foliage

    Living & Working in NH

    NH is an economically strong region with a low cost of living, including no state sales or income tax, outstanding schools, and safe and vibrant communities in which to raise a family. With mountains to the north, ocean to the east, and Boston to the south, our region offers opportunities for every lifestyle. The area is not only known for the premier medical and clinical excellence available but also for vast recreational opportunities for every lifestyle.

  • Person wearing scrubs and a stethoscope

    Benefits

    Southern New Hampshire Health supports and encourages the ongoing growth and development of all employees. We offer numerous programs to help employees learn and grow both personally and professionally.

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