Clinical Review RN PRN

- Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity. Performs utilization review in accordance with all state mandated regulations. - Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues. -  Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers. - Completes documentation of review and denial processes in the EPIC Case Management Module. Responds to requests from the payer for all required information and treatment plans. - Reviews and validates physician’s orders,...