ColoradoSpringsRecruiter
the smart solution for Colorado Springs jobs

RN Clinical Reviewer - Registered Nurse

Company: eviCore
Location: Colorado Springs
Posted on: October 10, 2018

Job Description:

Overview: Responsible for all clinical certification activities, which include but are not limited to evaluating telephone, fax or WEB requests for authorization of clinical services from physician offices/and or imaging centers, comparing requests against established clinical protocols and authorizing services or referring requests for expert clinical review as appropriate. Reviews clinical information submitted by providers to appropriate criteria and standards and makes decision to issue a review determination or to refer to physician review if criteria are not met. Maintains current departmental standards related to productivity. Trains in clinical certification, utilization management, URAC and NCQA principles, policies, and procedures. Prepares program correspondence as needed. Serves as a resource for members calling for assistance. Makes outbound calls as required. Refers provider and member complaints, and appeals to appropriate departments. Maintains patient confidentiality in accordance with eviCore standards established in compliance with HIPAA and State regulations. Provides outstanding customer service ensuring callers receive the highest possible service. Runs and analyzes reports to ensure all tasks are completed in a timely fashion and meet regulatory requirements. Assists team members in departmental chats, by phone and in person. Acts as training assistant when assigned. Assist team members with questions, participates in team meetings. Can be assigned to projects to support the department as needed. Performs related duties as required. Responsibilities: Current, unrestricted license as RN or LPN in state of primary residence or appropriate compact state. Must have at least 1 year of acute care, managed care, ER or ICU experience. Qualifications: Must be able to sit through shift, demonstrate advanced proficiency in MS Office applications. Excellent communication skills both verbal and written; excellent problem solving and customer service skills are required. Must be self directed and highly motivated with an ability to multi-task. Excellent computer skills. Must type at least 30 WPM. Must be able to hear and speak on the phone for an entire shift Apply for this position online Email this position to a friend Share on your newsfeed Connect With U

Keywords: eviCore, Colorado Springs , RN Clinical Reviewer - Registered Nurse, Healthcare , Colorado Springs, Colorado

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Healthcare Jobs


Certified Family Nurse Practitioner
Description: Role br The Nurse Practitioner is a licensed independent practitioner who is responsible for managing health problems and coordinating health care for the perioperative patient in accordance with State (more...)
Company: Castillo Primary Care
Location: Pueblo
Posted on: 10/20/2018

Caregiver - Golden
Description: About:Do you have a passion to help others Do you enjoy caring for people and making a difference in people's lives If so, come join our team as a caregiver FirstLight Home Care is
Company: FirstLight Home Care
Location: Golden
Posted on: 10/20/2018

Denial Medical Coders
Description: Please only apply if you meet the qualifications and your resume must reflect your work experience. PT
Company: Mommy Jobs Online
Location: Woodland Park
Posted on: 10/20/2018


OT - Occupational Therapist in PUEBLO , CO
Description: ul br li Location: PUEBLO, CO br li Setting:
Company: Ardor Health Solutions
Location: Pueblo
Posted on: 10/20/2018

Registered Nurse - RN - Critcal Care Float Pool
Description: You. br br You bring your body, mind, heart and spirit to your work as a Critical Care Float Pool Registered Nurse. br br Your compassion is tangible: whether your patient is 18 or 85, they feel (more...)
Company: SCL Health
Location: Wheat Ridge
Posted on: 10/20/2018

Medical Assistant Float
Description: Welcome to Centura HealthWelcome to Centura Health - the largest health ecosystem in Colorado and Kansas. Welcome to living your mission among thousands of people on fire to live theirs too. Welcome to (more...)
Company: Centura Health
Location: Lakewood
Posted on: 10/20/2018

Certified Nurse Assistants (CNA) - Hiring NOW!
Description: Are you a CNA looking for Full-Time work in an easy-going and fulfilling work environment We are looking for Nursing Assistants, with any level of experience, who want to
Company: CareInHomes
Location: Grand Lake
Posted on: 10/20/2018

Registered Nurse - Med Surg
Description: Registered Nurse - Med Surg Supplemental Health Care is a nationally recognized healthcare staffing provider partnering with a hospital
Company: Supplemental Health Care
Location: Englewood
Posted on: 10/20/2018

Registered Nurse - Surgical Trauma ICU -
Description: Facility: University of Colo Hospital Department: SICU Schedule: Full-time Shift: Rotating Scheduled Days Hours: Rotating Requisition number: 78567 Up to a 5000 sign-on bonus for those who qualify. (more...)
Company: UCHealth
Location: Aurora
Posted on: 10/20/2018

Cath Lab Tech
Description: MedPro Healthcare Staffing, a Joint Commission-certified staffing agency, is seeking a quality Cath Lab Tech for a contract with one of our top healthcare clients.Benefits of being a MedPro Employee (more...)
Company: MedPro Healthcare Staffing
Location: Loveland
Posted on: 10/20/2018

Log In or Create An Account

Get the latest Colorado jobs by following @recnetCO on Twitter!

Colorado Springs RSS job feeds