UTILIZATION REVIEW AND APPEALS RN

Carson Tahoe Health

  • Carson City, NV
  • Permanent
  • Full-time
  • 1 month ago
Job Description:DescriptionUS:NV:Carson City Case ManagementPer Diem Day ShiftAbout Carson Tahoe HealthCTH is a not-for-profit healthcare system with 240 licensed acute care beds, fully accredited by the Center for Improvement in Healthcare Quality (CIHQ). CTH was voted 5th most beautiful hospital in the nation nestled among the foothills of the Sierra Nevada in North Carson City and only a short drive away from world-famous Lake Tahoe & Reno. We serve a population of over 250,000 and feature two hospitals, two urgent cares, an emergent care center, outpatient services and a provider network with 19 regional locations.SummaryThis position is responsible for facilitating care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources while respecting patient’s right to self-determination. This position has the overall responsibility to maintain current knowledge of disease processes, available resources, treatment options appropriate to patient population and reviewing medical necessity, responding to authorization concerns, and/or reconciling coverage related issues. This position collaborates with medical staff, interdisciplinary team, and external resources to screen for accurate medical necessity and appeal appropriate accounts according to internal guidelines.QualificationsRequired:
  • Minimum (2) years of acute care hospital patient care experience
  • Current unrestricted registered nurse license in the State of Nevada
  • Organizational skills, excellent verbal & written communication skills, ability to lead, coordinate diverse group in fast paced environment, critical thinking, problem solving and negotiation skills
Preferred:
  • Two (2) years of experience as acute care case manager
  • Bachelor of Science in Nursing
  • Ability to obtain Accredited Case Manager (ACM) certification
Top 5 Reasons to Live in Carson City, Nevada
  • Live, work and play in one of the most beautiful regions in the world
  • Enjoy an array of outdoor activities world class skiing, golf, camping, mountain biking, hiking, water skiing, kayaking, hunting and fishing
  • Just next door is Beautiful Lake Tahoe
  • We are minutes from Reno known as the 'biggest little city in the world' - Fine dining, nightlife, shopping and home to the University of Nevada Reno.
  • Family friendly atmosphere with affordable housing & excellent school system
Our Benefits
  • No State Income Tax
  • Medical, Dental, Vision, FSA, Telehealth
  • Paid Time Off, Mental Health, and Volunteer Days
  • 100% Vested 401K & Roth with Company Contribution
  • Tuition Reimbursement
  • Referral Bonuses
  • On Site Education & Certification Programs
  • Base Wage Increases for Relevant Advanced Degrees
  • Free Calm App Subscription

Carson Tahoe Health