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RN Clinical Access Specialist - Utilization Management in Danville, PA for Geisinger
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RN Clinical Access Specialist - Utilization Management
Job SummaryPerforms initial, concurrent and retrospective medical record review to determine medical necessity for acute care admission based on the application of nationally recognized acute care criteria, federal and state mandates and regulatory body requirements.Job DutiesPerforms and ensures adherence to state, federal and third party payer certification requirements for initial, concurrent and retrospective medical record review for medical necessity and level of care determination.Identifies and notifies appropriate staff regarding discrepancy issues with third party payer health insurance coverage and lack of coverage.Maintains a working knowledge of third party payer health plans, working knowledge of nationally recognized review cr


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Case Management Society of America
5034A Thoroughbred Lane
Brentwood, TN 37027