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Clinical Review Nurse

Tampa, FL
Clinical Review Nurse
Tampa, FL 33609
$37-$39hr (weekly pay)
Contract to Hire - temp to permanent 
Benefits: Medical/Dental/Vision 


Our client, a leader in healthcare technology, is seeking a Clinical Review Nurse that will be responsible for conducting clinical reviews to justify and dispute payer denials.  The role will develop case studies, coordinate with hospital operations and payers to ensure optimal results in denial prevention.

Responsibilities:
  • Provide clinical argument, using available Medical Records, to justify and dispute payer denials, all levels of appeals included.
  • Develop monthly case studies, identifying payer and hospital operational opportunities.
  • Compile reports as requesting by the ROS client and operations, specific to payers, operations and clinical reviews.
  • Participate in performance meetings as requested by ROS client and operations.
  • Develop and conduct quality reviews of all clinical reviews, including training.
  • Provide clinical argument, using available Medical Records, to justify and dispute payer denials, all levels of appeals included.
  • Develop monthly case studies, identifying payer and hospital operational opportunities
  • Compile reports as requesting by the ROS client and operations, specific to payers, operations and clinical reviews
  • Participate in performance meetings as requested by ROS client and operations
  • Develop and conduct quality reviews of all clinical reviews, including training.
Qualifications:
  • Bachelor of Science in Nursing or Utilization or Case Management.
  • Must have a valid Florida or multistate license as a Registered Nurse.
  • 5 Years’ experience in Utilization Review or Case Management.
  • Extensive knowledge in evidence-based protocol – Hospital Case Management.
  • Excellent verbal and written skills.
  • Ability to analyze and present to both leadership and operational teams
  • Proficient in Microsoft Office (Excel, Word, PowerPoint)
  • Must complete background check and drug screen.
Please submit your resume for consideration!
#ZR
 
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