Registered Nurse

Pediatric, geriatric, general long term care experience, previous utilization review experience. Shifts available vary between hours of 7am-7pm.

"RESPONSIBILITIES: 

Reviews and analyzes medical necessity documentation and assessments according to established criteria and protocols. 

Produces decisions as required based on knowledge of Medicaid requirements and training as a Registered Nurse. 

Maintains appropriate documentation and support for all requests.

 Participates in Fair Hearings as assigned. Reviews complaints and appeals by providers; investigates and evaluates facts and advises disposition.. 

Manages incoming phone calls from the provider and customer communities. 

Cross trains to other areas and assists as required. 

Other duties as assigned by Manager. 

" Perform reviews and assessments for medical necessity. Coordinate and send to Physician for further review based on MN. 

Participate in Fair hearing process, provide customer svc via Phone Que. 

THANKS AND REGARDS,

ASMA KHAN SURI.

Must be able to pass a background and drug screen