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Rn Case Manager / Utilization Review
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- Networks Connect Professional Staffing is conducting a search on behalf of our client, one of the fastest growing Hospital Systems in the Silver Spring area, who is searching for a Utilization Review Nurse/Case Manager for their Payor Reimbursement Analyst position.
- Conduct timely, comprehensive, and accurate reviews of authorizations and denials to determine appropriate actions.
- Submit timely appeals based on standardized criteria (Interqual and MCG) and adhere to escalation processes.
- Serve as a subject matter expert for CRM, Revenue Cycle, and the organization.
- Track, trend, and analyze all authorization issues and denials by payer using relevant software.
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