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Registered Nurse RN - Clinic Utilization Review - 93K - K Per Year
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- VNS Health is seeking a Registered Nurse (RN) Clinic Utilization Review for a nursing job in Secaucus, New Jersey.
- Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: ASAP Duration: Ongoing Employment Type: Staff Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health.
- Creates and maintains accurate records documenting the actions and rationale for each grievance or appeal decision.
- Conducts review of requests for prior authorization of health services, as required in certain product lines, and prepares written responses consistent with regulatory requirements.
- External reviewers include New York State (Fair Hearings), Centers for Medicare and Medicaid Services (CMS), Independent Review Entities and Quality Improvement Organizations.
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