Certified Medical Necessity Reviewer

7 days ago


Schertz, Texas, United States Nexus Enterprise Full time

Join Nexus Enterprise, a leading healthcare organization, as a Certified Medical Necessity Reviewer - Utilization Management. In this role, you will play a critical part in ensuring the quality and appropriateness of medical services provided to patients.

About the Role

We are seeking an experienced nurse with a strong background in clinical practice to join our team. As a Certified Medical Necessity Reviewer - Utilization Management, you will be responsible for analyzing medical records and determining the medical necessity of treatments and services.

The ideal candidate will have excellent analytical and communication skills, with the ability to interpret complex medical information and present findings in a clear and concise manner. You will work closely with physicians, clients, and other healthcare professionals to ensure that patients receive high-quality care.

Responsibilities
  • Analyze medical records to determine the medical necessity of treatments and services
  • Interpret and apply relevant guidelines and criteria to validate medical necessity
  • Communicate findings and recommendations to physicians, clients, and other stakeholders
  • Collaborate with healthcare professionals to ensure continuity of care
Requirements
  • Bachelor's degree in Nursing from an accredited institution
  • Current RN or LVN licensure without restrictions
  • 3-5 years of clinical nursing experience
  • Prior experience in utilization management (preferred)
Benefits

Nexus Enterprise offers a competitive salary range of $65,000 - $85,000 per year, depending on experience. We also offer a comprehensive benefits package, including health insurance, retirement savings plan, and paid time off.

About Nexus Enterprise

Nexus Enterprise is a dynamic and innovative healthcare organization dedicated to providing high-quality care to our patients. We are committed to fostering a collaborative and supportive work environment that promotes professional growth and development.



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