Travel Nurse RN - Case Management
Plymouth, MA
Enterprise Solutions, Inc (NimbusNest, Inc)
5x8 hrs, Days
Referral Bonus

Position Description 

8H day shift, rotating weekends. 

Required: MA license, BLS-AHA, 3-5 years experience in setting, Preferred: ACM, CCM or CMAC -- 

Duties/Responsibilities: • Reviews admission data to establish the appropriate level of care using Interqual criteria. • Integrates clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient. • Conducts concurrent reviews to determine the continued need for acute care setting, appropriateness and timeliness of treatments/procedures and to optimize the potential for reimbursement. • Collaborates with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process. • Collaborates with UR Manager and/or physician advisor regarding cases that do not meet established guidelines for admission or continued stay. • Acts as a liaison between physicians and payers, coordinating peer-to-peer phone calls. • Collects and compiles data as required. -- 

NO local travelers will be accepted (cannot reside within 50 mi from the facility)