Offer summary
Qualifications:
Active and unrestricted RN license in Pennsylvania., Minimum 5 years in higher-level clinical roles., 1 year of UM experience in managed care., Knowledge of medical coding guidelines., Certifications: CCM or ACM within 2 years..
Key responsabilities:
- Process inpatient requests for medical necessity criteria.
- Interpret and apply relevant clinical guidelines.
- Collaborate with staff for final determinations.
- Identify and refer complex needs members.
- Suggest improvements and maintain departmental standards.