Nurse Case Manager
3 days ago
Responsibilities:
- Investigate and respond to written appeals and reconsideration requests.
- Compile and organize clinical, contractual, medical policy, and claims information for physician review.
- Formulate recommendations for disposition and prepare the written case for review.
Qualifications:
- Education: High School Diploma or GED
- Licenses/Certifications:
- RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon Hire Required
- CCM - Certified Case Manager Upon Hire Preferred
- LNCC - Legal Nurse Consultant Certified Upon Hire Preferred
- Experience:
- 2 years medical-surgical or similar clinical experience OR 3 years' experience in mental health, psychiatric setting
- Preferred Qualifications:
- 2 years' experience in Medical Review, Utilization Management or Case Management at CareFirst BlueCross BlueShield, or similar Managed Care organization or hospital preferred.
- BSN/MSN Degree. Government Program experience with Appeals and Grievance, Experience with MCG, InterQual, NCD and LCD's.
Sponsorship in US: Must be eligible to work in the U.S. without Sponsorship.
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