FranklinRecruiter
the smart solution for Franklin jobs

Registered Nurse - Clinical Reviewer

Company: EviCore Healthcare
Location: Franklin
Posted on: September 16, 2018

Job Description:

Summary Want to know what a "day in the life" looks like for an eviCore Clinical Reviewer? Watch this video to learn more! THIS POSITION IS LOCATED IN Franklin, TN REMOTE POSSIBILITY AFTER 90 DAYS. 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. **First 90 days of employment must be onsite at our Franklin, TN Call Center** eviCore is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigationMinimum Experience Required

  • Current, unrestricted license as LPN/RN in Tennessee.
  • Must have at least 1 year of acute care, managed care, ER or ICU experience. Required Skills Minimum Experience: Must have at least 1 year of acute care, managed care, ER or ICU experience.

    Keywords: EviCore Healthcare, Franklin , Registered Nurse - Clinical Reviewer, Healthcare , Franklin, Tennessee

    Click here to apply!

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


    I'm looking for
    in category
    within


  • Other Healthcare Jobs


    Travel Registered Nurse - Medical Intensive Care Unit - MICU - RN (Nashville,TN)
    Description: Registered Nurse. Travel
    Company: HealthCare Travel Jos
    Location: Nashville
    Posted on: 09/21/2018

    Cardiac Progressive Care Registered Nurse
    Description: TriStar Centennial Medical Center - Nashville, TN Registered Nurse RN - 6 Tower - Cardiac Step-Down Our 657 bed hospital is both nationally and locally recognized, including being named as one of the (more...)
    Company: Centennial Medical Center HCA Healthcare
    Location: Nashville
    Posted on: 09/21/2018

    Physician / Nurse Practitioner / Tennessee / Permanent / Advanced Prac
    Description: TriStar Centennial Medical Center in downtown Nashville, Tennessee is seeking
    Company: HCA Physician Recruitment
    Location: Nashville
    Posted on: 09/21/2018


    Registered Nurse (RN) Contract Travel Premium Pay
    Description: Registered Nurse RN Contract Travel Premium Pay Job ID: 276243 Registered Nurse RN Contract Travel Premium Pay Murfreesboro, Tennessee Temporary / RotatingAdditional Job Information Title: RN-Float (more...)
    Company: Saint Thomas, TN
    Location: Murfreesboro
    Posted on: 09/21/2018

    Physician / Endocrinology / Tennessee / Permanent / Additional Endocri
    Description: Looking for a Board Certified Endocrinologist to join a thriving 4 physician general Endocrinology practice within The Frist Clinic, a multispecialty group in the heart of Nashville, TN. Affiliated
    Company: HCA Physician Recruitment
    Location: Nashville
    Posted on: 09/21/2018

    Physician / Surgery - Neurological / Tennessee / Permanent / Seeking a
    Description: The Childrens Hospital at Tristar Centennial is one of the most rapidly growing childrens hospitals in the HCA Hospital Corporation of America family. Due to community need, we are searching for a Pediatric (more...)
    Company: HCA Physician Recruitment
    Location: Nashville
    Posted on: 09/21/2018

    RN Registered Nurse - Cardiac Short Stay
    Description: Job ID: 255802 RN Registered Nurse - Cardiac Short Stay Nashville, Tennessee Regular Additional Job Information RN Registered Nurse - Cardiac Short Stay--RN Registered Nurse - Cardiac Telemetry 4C - Short (more...)
    Company: Saint Thomas, TN
    Location: Nashville
    Posted on: 09/21/2018

    Telecommute Healthcare consultant
    Description: Seeking motivated individual to work from home and fill healthcare position . Work part time hours making
    Company: Ameriplan
    Location: Nashville
    Posted on: 09/21/2018

    Registered Nurse (RN) - Cardiac - Contract - Travel - Premium Pay
    Description: Job ID: 275874 Registered Nurse RN - Cardiac - Contract - Travel - Premium Pay Nashville, Tennessee Temporary Additional Job Information Title:--RN-FloatCity, State:-- Nashville,TNLocation:-- St Thomas (more...)
    Company: Saint Thomas, TN
    Location: Nashville
    Posted on: 09/21/2018

    Hospice Aide - PRN (TN, Nashville)
    Description: JOB ADVERTISEMENT br br As a Hospice Aide at AseraCare, you'll nurture our patients, providing comprehensive support to make life easier through their personalized
    Company: Aseracare
    Location: Nashville
    Posted on: 09/21/2018

    Log In or Create An Account

    Username:
    Password:
     

    Forgot password?


    Find us on Facebook

    Find us on LinkedIn

    Get the latest Tennessee jobs by following @recnetTN on Twitter!

    Franklin RSS job feeds