Medical Claims Review Nurse Job - (sacramento, california)
Medical Claims Review Nurse needed for a contract opportunity with Yohs client located in Sacramento, CA.
The Big Picture :
Top Skills You Should Possess:
:
Utilization Management experience :
Knowledge of CPT and ICD:
9 coding What Youll Be Doing:
:
Perform retroactive review of claims requiring medical review, edits, and medical necessity submitted with and/or without prior authorization :
Review, refer and manage possible CCS cases What You Need to Bring to the Table:
:
Current California RN or LVN license :
Three (3) years recent utilization management or quality management experience in a clinical setting :
Strong knowledge / understanding of CPT, HCPCS and ICD:
9 coding required :
Strong knowledge / understanding of RBRVS:
based and Medi:
Cal fee schedules or payment systems required :
Understanding of the National Correct Coding Initiative and CPT coding rules / standards :
In:
depth knowledge of AB:
1455, regulations and procedures governing Medi:
Cal and other state sponsored programs :
Direct experience in utilization management and/or quality management is required Bonus Points Otherwise Known As Preferred
Qualifications:
:
Masters Degree in Nursing or a related field preferred :
Working familiarity with the basic principles of contract law, risk management and health care economics What are you waiting for? Apply Now Recruiter:
Jennifer Andersen Yoh makes finding and applying for jobs simple.
Partner with Yoh to find the right opportunities across multiple industries in the US and UK.
Find out more here MONJOB J2WNWHLTH Ref:
SFSF:
REN Source:
.
Estimated Salary: $20 to $28 per hour based on qualifications.
The Big Picture :
Top Skills You Should Possess:
:
Utilization Management experience :
Knowledge of CPT and ICD:
9 coding What Youll Be Doing:
:
Perform retroactive review of claims requiring medical review, edits, and medical necessity submitted with and/or without prior authorization :
Review, refer and manage possible CCS cases What You Need to Bring to the Table:
:
Current California RN or LVN license :
Three (3) years recent utilization management or quality management experience in a clinical setting :
Strong knowledge / understanding of CPT, HCPCS and ICD:
9 coding required :
Strong knowledge / understanding of RBRVS:
based and Medi:
Cal fee schedules or payment systems required :
Understanding of the National Correct Coding Initiative and CPT coding rules / standards :
In:
depth knowledge of AB:
1455, regulations and procedures governing Medi:
Cal and other state sponsored programs :
Direct experience in utilization management and/or quality management is required Bonus Points Otherwise Known As Preferred
Qualifications:
:
Masters Degree in Nursing or a related field preferred :
Working familiarity with the basic principles of contract law, risk management and health care economics What are you waiting for? Apply Now Recruiter:
Jennifer Andersen Yoh makes finding and applying for jobs simple.
Partner with Yoh to find the right opportunities across multiple industries in the US and UK.
Find out more here MONJOB J2WNWHLTH Ref:
SFSF:
REN Source:
.
Estimated Salary: $20 to $28 per hour based on qualifications.
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