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Summary:
- Responsible for application of appropriate medical necessity tools to maintain compliance.
- Acts as a resource to other team members to support UR and revenue cycle process.
- Remote work position available after in-office training.
Position Responsibilities:
- Utilizes Payer specific screening tools as a resource to assist in the determination process.
- Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care.
- Identify and manage concurrent and retroactive denials through communication with attending physicians.
Required / Experience Required:
- RN and 3 years clinical nursing experience required.
- 1 year UR/CM/QM experience.
Virtua Health
Virtua Health strives to connect individuals to the care they need, building a healthier community in South Jersey. They are a Magnet-recognized health system with over 14,000 colleagues, including over 2,850 doctors, physician assistants, and nurse practitioners.