|Department:||Care Management Services|
|Hours per week:||40|
|Job Details:||Nurse RN|
Under the direction of the Appeals Manager, integrates cost, quality and utilization to facilitate maximum reimbursement for services rendered utilizing Interqual and Milliman Guidelines. Understands the utilization and denial processes. Employs utilization, clinical, and coding expertise to ensure healthcare services rendered are reimbursed appropriately. Understands payer auditing process and participates as assigned. Initiates and directs the appeal process in response to the audit findings.
Minimum Job Qualifications: