A company is looking for a UM Review Nurse to assist its Health Services Department. Key Responsibilities
Complete prior authorization and retrospective review of medical services
Refer cases to Medical Directors as necessary
Maintain knowledge of regulations and comply with internal policies
R
Key Responsibilities
Review and document prior authorization and appeals requests, along with member case history
Analyze trends and recommend revisions to medical policies and utilization management based on case reviews
Interface with members, providers, and internal departments to ensure effe
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About Us: At Sinai Chicago, we take health care personally. Excellence in health care is about more than just medicine, technology, tests and treatments, it is about really caring for people with dignity and respect. That's what we do.
Key Responsibilities:
Review prior authorization requests for medical necessity and collaborate with Medical Directors as needed
Utilize evidence-based criteria and governmental policies for medical necessity reviews and manage claims disputes
Coordinate transitions of care and referrals to Care
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