Utilization Review Nurse-RN- Per Diem/Days

Job description

Job Summary: Responsible for day-to-day review, coordination and management of Clinical denials requiring background and understanding from a provider operational and payer logistical perspective. Auditor must work with a diverse group of other health care professionals to conduct review and appeal of Clinical denials related to all Payor plans. Represents Avanti Hospitals from a system perspective when working with payers to challenge and overturn denials of Clinical nature. Manages overturn rate data and evaluates trends for improvement opportunities. Works as part of the team to develop meaningful information for Hospitals and other stakeholders to improve operational performance and cash collections. Nurse auditor must have knowledge of government/State policies. The auditor should have strong project management and analytical skills and be able to handle projects simultaneously. Auditor should be able to work well individually or as part of a team. Assists with chart and Defense audits with outside payors. Assist with CDM charge and coding reviews. Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County...